|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH83EZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02PA0MZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 00HE0MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH70BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 01HY0MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH73BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 4A027N7
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD X2RF332
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH63BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH60BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH60MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02PA4MZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
OP
|
$35.85
|
|
|
Service Code
|
NDC 72205-051-08
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$30.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.36
|
| Rate for Payer: BCBS Transplant Transplant |
$21.51
|
| Rate for Payer: Blue Shield of California Commercial |
$26.42
|
| Rate for Payer: Blue Shield of California EPN |
$20.94
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cigna of CA HMO |
$25.10
|
| Rate for Payer: Cigna of CA PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.47
|
| Rate for Payer: Dignity Health Media |
$30.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.34
|
| Rate for Payer: Galaxy Health WC |
$30.47
|
| Rate for Payer: Global Benefits Group Commercial |
$21.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$28.68
|
| Rate for Payer: Networks By Design Commercial |
$23.30
|
| Rate for Payer: Prime Health Services Commercial |
$30.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.92
|
| Rate for Payer: United Healthcare All Other HMO |
$17.92
|
| Rate for Payer: United Healthcare HMO Rider |
$17.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.47
|
| Rate for Payer: Vantage Medical Group Senior |
$30.47
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
NDC 31722-935-02
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Blue Shield of California Commercial |
$25.63
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
IP
|
$35.85
|
|
|
Service Code
|
NDC 72205-051-08
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$30.47 |
| Rate for Payer: Blue Shield of California Commercial |
$25.53
|
| Rate for Payer: Blue Shield of California EPN |
$18.36
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cigna of CA HMO |
$25.10
|
| Rate for Payer: Cigna of CA PPO |
$25.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.34
|
| Rate for Payer: Galaxy Health WC |
$30.47
|
| Rate for Payer: Global Benefits Group Commercial |
$21.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$28.68
|
| Rate for Payer: Networks By Design Commercial |
$23.30
|
| Rate for Payer: Prime Health Services Commercial |
$30.47
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
NDC 31722-935-02
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.45
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.53
|
| Rate for Payer: Blue Shield of California EPN |
$21.02
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Media |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| 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: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$21.60
|
| 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 |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| 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
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$333.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$333.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$333.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$333.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$333.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Media |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$87.05
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$85.98
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
