|
5A02116
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 5A02116
|
| Hospital Charge Code |
2768
|
| Min. Negotiated Rate |
$134,914.00 |
| Max. Negotiated Rate |
$134,914.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,914.00
|
|
|
5A02116
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 5A02116
|
| Hospital Charge Code |
2769
|
| Min. Negotiated Rate |
$134,914.00 |
| Max. Negotiated Rate |
$134,914.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,914.00
|
|
|
5A0211D
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 5A0211D
|
| Hospital Charge Code |
2770
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
5A02216
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 5A02216
|
| Hospital Charge Code |
2771
|
| Min. Negotiated Rate |
$134,914.00 |
| Max. Negotiated Rate |
$134,914.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,914.00
|
|
|
5A02216
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 5A02216
|
| Hospital Charge Code |
2772
|
| Min. Negotiated Rate |
$134,914.00 |
| Max. Negotiated Rate |
$134,914.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,914.00
|
|
|
5A1213Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 5A1213Z
|
| Hospital Charge Code |
2773
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
8E023DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 8E023DZ
|
| Hospital Charge Code |
2774
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 3172256224
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
NDC 3172256224
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 6808402111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.80
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$7.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.00
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 3172255760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 3172255760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
NDC 6808402111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.14
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$7.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.00
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
IP
|
$160.57
|
|
|
Service Code
|
NDC 4970223113
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Adventist Health Commercial |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$123.48
|
| Rate for Payer: Blue Shield of California Commercial |
$81.41
|
| Rate for Payer: Cash Price |
$72.26
|
| Rate for Payer: Cigna of CA HMO |
$112.40
|
| Rate for Payer: Cigna of CA PPO |
$112.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.23
|
| Rate for Payer: EPIC Health Plan Senior |
$64.23
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Multiplan Commercial |
$128.46
|
| Rate for Payer: Networks By Design Commercial |
$104.37
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
OP
|
$160.57
|
|
|
Service Code
|
NDC 4970223113
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Adventist Health Commercial |
$32.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.04
|
| Rate for Payer: Cash Price |
$72.26
|
| Rate for Payer: Cigna of CA HMO |
$112.40
|
| Rate for Payer: Cigna of CA PPO |
$112.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.23
|
| Rate for Payer: EPIC Health Plan Senior |
$64.23
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.40
|
| Rate for Payer: Multiplan Commercial |
$128.46
|
| Rate for Payer: Networks By Design Commercial |
$104.37
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.28
|
| Rate for Payer: United Healthcare All Other HMO |
$80.28
|
| Rate for Payer: United Healthcare HMO Rider |
$80.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.48
|
| Rate for Payer: Vantage Medical Group Senior |
$136.48
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6909736202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6909736202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]
|
Facility
|
OP
|
$1,925.10
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$1,636.34 |
| Rate for Payer: Adventist Health Commercial |
$385.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.02
|
| Rate for Payer: Blue Shield of California Commercial |
$70.20
|
| Rate for Payer: Cash Price |
$866.30
|
| Rate for Payer: Cash Price |
$866.30
|
| Rate for Payer: Cigna of CA HMO |
$1,347.57
|
| Rate for Payer: Cigna of CA PPO |
$1,347.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,347.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.67
|
| Rate for Payer: EPIC Health Plan Senior |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$1,636.34
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$75.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,222.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.45
|
| Rate for Payer: Multiplan Commercial |
$1,540.08
|
| Rate for Payer: Networks By Design Commercial |
$962.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,155.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,155.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$722.49
|
| Rate for Payer: United Healthcare All Other HMO |
$703.24
|
| Rate for Payer: United Healthcare HMO Rider |
$688.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$45.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]
|
Facility
|
IP
|
$1,925.10
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$385.02 |
| Max. Negotiated Rate |
$1,636.34 |
| Rate for Payer: Adventist Health Commercial |
$385.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.40
|
| Rate for Payer: Blue Shield of California Commercial |
$976.03
|
| Rate for Payer: Cash Price |
$866.30
|
| Rate for Payer: Cigna of CA HMO |
$1,347.57
|
| Rate for Payer: Cigna of CA PPO |
$1,347.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,347.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.04
|
| Rate for Payer: EPIC Health Plan Senior |
$770.04
|
| Rate for Payer: Galaxy Health WC |
$1,636.34
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,222.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,135.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.02
|
| Rate for Payer: Multiplan Commercial |
$1,540.08
|
| Rate for Payer: Networks By Design Commercial |
$962.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$722.49
|
| Rate for Payer: United Healthcare All Other HMO |
$703.24
|
| Rate for Payer: United Healthcare HMO Rider |
$688.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.47
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$17,136.12
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$13,686.35 |
| Max. Negotiated Rate |
$17,136.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,686.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,136.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,332.32
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$33,732.64
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$26,941.73 |
| Max. Negotiated Rate |
$33,732.64 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,941.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,732.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,181.83
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$10,183.24
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$8,133.19 |
| Max. Negotiated Rate |
$10,183.24 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,133.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,183.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,111.32
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$13,220.54
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$10,559.04 |
| Max. Negotiated Rate |
$13,220.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,559.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,220.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,828.91
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
IP
|
$370.93
|
|
|
Service Code
|
NDC 0002481554
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.19 |
| Max. Negotiated Rate |
$315.29 |
| Rate for Payer: Adventist Health Commercial |
$74.19
|
| Rate for Payer: Blue Shield of California Commercial |
$188.06
|
| Rate for Payer: Blue Shield of California Commercial |
$285.25
|
| Rate for Payer: Cash Price |
$166.92
|
| Rate for Payer: Cigna of CA HMO |
$259.65
|
| Rate for Payer: Cigna of CA PPO |
$259.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.37
|
| Rate for Payer: EPIC Health Plan Senior |
$148.37
|
| Rate for Payer: Galaxy Health WC |
$315.29
|
| Rate for Payer: Global Benefits Group Commercial |
$222.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.02
|
| Rate for Payer: Multiplan Commercial |
$296.74
|
| Rate for Payer: Networks By Design Commercial |
$241.10
|
| Rate for Payer: Prime Health Services Commercial |
$315.29
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
OP
|
$370.93
|
|
|
Service Code
|
NDC 0002481554
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.19 |
| Max. Negotiated Rate |
$315.29 |
| Rate for Payer: Adventist Health Commercial |
$74.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.03
|
| Rate for Payer: Cash Price |
$166.92
|
| Rate for Payer: Cigna of CA HMO |
$259.65
|
| Rate for Payer: Cigna of CA PPO |
$259.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.37
|
| Rate for Payer: EPIC Health Plan Senior |
$148.37
|
| Rate for Payer: Galaxy Health WC |
$315.29
|
| Rate for Payer: Global Benefits Group Commercial |
$222.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.65
|
| Rate for Payer: Multiplan Commercial |
$296.74
|
| Rate for Payer: Networks By Design Commercial |
$241.10
|
| Rate for Payer: Prime Health Services Commercial |
$315.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.47
|
| Rate for Payer: United Healthcare All Other HMO |
$185.47
|
| Rate for Payer: United Healthcare HMO Rider |
$185.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.29
|
| Rate for Payer: Vantage Medical Group Senior |
$315.29
|
|
