|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
IP
|
$832.93
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.59 |
| Max. Negotiated Rate |
$707.99 |
| Rate for Payer: Adventist Health Commercial |
$166.59
|
| Rate for Payer: Blue Shield of California Commercial |
$422.30
|
| Rate for Payer: Blue Shield of California Commercial |
$640.52
|
| Rate for Payer: Cash Price |
$374.82
|
| Rate for Payer: Cigna of CA HMO |
$583.05
|
| Rate for Payer: Cigna of CA PPO |
$583.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.17
|
| Rate for Payer: EPIC Health Plan Senior |
$333.17
|
| Rate for Payer: Galaxy Health WC |
$707.99
|
| Rate for Payer: Global Benefits Group Commercial |
$499.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.90
|
| Rate for Payer: Multiplan Commercial |
$666.34
|
| Rate for Payer: Networks By Design Commercial |
$416.46
|
| Rate for Payer: Prime Health Services Commercial |
$707.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.60
|
| Rate for Payer: United Healthcare All Other HMO |
$304.27
|
| Rate for Payer: United Healthcare HMO Rider |
$297.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.78
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
IP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$442.48 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Blue Shield of California Commercial |
$263.93
|
| Rate for Payer: Blue Shield of California Commercial |
$400.32
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Cigna of CA HMO |
$364.40
|
| Rate for Payer: Cigna of CA PPO |
$364.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.23
|
| Rate for Payer: EPIC Health Plan Senior |
$208.23
|
| Rate for Payer: Galaxy Health WC |
$442.48
|
| Rate for Payer: Global Benefits Group Commercial |
$312.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.94
|
| Rate for Payer: Multiplan Commercial |
$416.46
|
| Rate for Payer: Networks By Design Commercial |
$260.29
|
| Rate for Payer: Prime Health Services Commercial |
$442.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.37
|
| Rate for Payer: United Healthcare All Other HMO |
$190.16
|
| Rate for Payer: United Healthcare HMO Rider |
$186.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.49
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
OP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$2,208.51 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.61
|
| Rate for Payer: Blue Shield of California Commercial |
$496.69
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Cigna of CA HMO |
$364.40
|
| Rate for Payer: Cigna of CA PPO |
$364.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.77
|
| Rate for Payer: EPIC Health Plan Senior |
$365.18
|
| Rate for Payer: Galaxy Health WC |
$442.48
|
| Rate for Payer: Global Benefits Group Commercial |
$312.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$544.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$444.85
|
| Rate for Payer: Multiplan Commercial |
$416.46
|
| Rate for Payer: Networks By Design Commercial |
$260.29
|
| Rate for Payer: Prime Health Services Commercial |
$442.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.37
|
| Rate for Payer: United Healthcare All Other HMO |
$190.16
|
| Rate for Payer: United Healthcare HMO Rider |
$186.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$331.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Vantage Medical Group Senior |
$365.18
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$542.39
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$461.03 |
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Blue Shield of California Commercial |
$274.99
|
| Rate for Payer: Blue Shield of California Commercial |
$417.10
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cigna of CA HMO |
$379.67
|
| Rate for Payer: Cigna of CA PPO |
$379.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.96
|
| Rate for Payer: EPIC Health Plan Senior |
$216.96
|
| Rate for Payer: Galaxy Health WC |
$461.03
|
| Rate for Payer: Global Benefits Group Commercial |
$325.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$320.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.17
|
| Rate for Payer: Multiplan Commercial |
$433.91
|
| Rate for Payer: Networks By Design Commercial |
$271.19
|
| Rate for Payer: Prime Health Services Commercial |
$461.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other HMO |
$198.14
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.63
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
OP
|
$542.39
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$2,208.51 |
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.61
|
| Rate for Payer: Blue Shield of California Commercial |
$496.69
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cigna of CA HMO |
$379.67
|
| Rate for Payer: Cigna of CA PPO |
$379.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.77
|
| Rate for Payer: EPIC Health Plan Senior |
$365.18
|
| Rate for Payer: Galaxy Health WC |
$461.03
|
| Rate for Payer: Global Benefits Group Commercial |
$325.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$544.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$444.85
|
| Rate for Payer: Multiplan Commercial |
$433.91
|
| Rate for Payer: Networks By Design Commercial |
$271.19
|
| Rate for Payer: Prime Health Services Commercial |
$461.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other HMO |
$198.14
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$331.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Vantage Medical Group Senior |
$365.18
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487590199
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487590199
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
OP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.91
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cigna of CA HMO |
$76.72
|
| Rate for Payer: Cigna of CA PPO |
$88.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.92
|
| Rate for Payer: Multiplan Commercial |
$95.90
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.94
|
| Rate for Payer: United Healthcare All Other HMO |
$59.94
|
| Rate for Payer: United Healthcare HMO Rider |
$59.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.90
|
| Rate for Payer: Vantage Medical Group Senior |
$101.90
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
IP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California Commercial |
$60.78
|
| Rate for Payer: Blue Shield of California Commercial |
$92.19
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.77
|
| Rate for Payer: Multiplan Commercial |
$95.90
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$29,519.16
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$23,576.49 |
| Max. Negotiated Rate |
$29,519.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,576.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,519.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,411.88
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$14,536.61
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$11,610.16 |
| Max. Negotiated Rate |
$14,536.61 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,610.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,536.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,006.44
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$127,329.23
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$127,329.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$127,329.23
|
| Rate for Payer: EPIC Health Plan Senior |
$84,886.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77,169.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108,036.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103,406.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$48,063.81
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$38,387.80 |
| Max. Negotiated Rate |
$48,063.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38,387.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48,063.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,004.46
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$79,622.45
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$63,593.19 |
| Max. Negotiated Rate |
$79,622.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63,593.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79,622.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,241.13
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
IP
|
$60,372.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12,074.40 |
| Max. Negotiated Rate |
$51,316.20 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30,608.60
|
| Rate for Payer: Blue Shield of California Commercial |
$46,426.07
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,260.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,148.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24,148.80
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,336.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,619.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,489.28
|
| Rate for Payer: Multiplan Commercial |
$48,297.60
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,657.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22,053.89
|
| Rate for Payer: United Healthcare HMO Rider |
$21,576.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,771.83
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
OP
|
$60,372.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$181.55 |
| Max. Negotiated Rate |
$51,316.20 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.80
|
| Rate for Payer: Blue Shield of California Commercial |
$25,416.61
|
| Rate for Payer: Blue Shield of California Commercial |
$38,517.34
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cigna of CA HMO |
$38,638.08
|
| Rate for Payer: Cigna of CA PPO |
$44,675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,260.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.56
|
| Rate for Payer: EPIC Health Plan Senior |
$199.71
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$181.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,336.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,489.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$243.28
|
| Rate for Payer: Multiplan Commercial |
$48,297.60
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,223.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,657.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22,053.89
|
| Rate for Payer: United Healthcare HMO Rider |
$21,576.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,771.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$181.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Vantage Medical Group Senior |
$199.71
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5026869415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5026869411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 4359850530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5026869415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 4359850530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5026869411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
IP
|
$42.62
|
|
|
Service Code
|
NDC 0006022761
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Blue Shield of California Commercial |
$32.77
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO |
$29.83
|
| Rate for Payer: Cigna of CA PPO |
$29.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.05
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$36.23
|
| Rate for Payer: Global Benefits Group Commercial |
$25.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$34.10
|
| Rate for Payer: Networks By Design Commercial |
$27.70
|
| Rate for Payer: Prime Health Services Commercial |
$36.23
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
OP
|
$42.62
|
|
|
Service Code
|
NDC 0006022761
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.35
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO |
$29.83
|
| Rate for Payer: Cigna of CA PPO |
$29.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.05
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$36.23
|
| Rate for Payer: Global Benefits Group Commercial |
$25.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.83
|
| Rate for Payer: Multiplan Commercial |
$34.10
|
| Rate for Payer: Networks By Design Commercial |
$27.70
|
| Rate for Payer: Prime Health Services Commercial |
$36.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.31
|
| Rate for Payer: United Healthcare All Other HMO |
$21.31
|
| Rate for Payer: United Healthcare HMO Rider |
$21.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.23
|
| Rate for Payer: Vantage Medical Group Senior |
$36.23
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 6586247601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
