|
TERBUTALINE 1 MG/ML MED NEB SOLUTION [192332]
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Adventist Health Commercial |
$4.73
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$16.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$9.46
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$20.09
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$14.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$18.91
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$11.82
|
| Rate for Payer: Prime Health Services Commercial |
$20.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$8.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$20.09
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
|
|
TERBUTALINE 1 MG/ML MED NEB SOLUTION [192332]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California Commercial |
$18.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$9.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$20.09
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$14.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$18.91
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$11.82
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$20.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$8.64
|
| Rate for Payer: United Healthcare HMO Rider |
$8.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$4.73
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$18.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$16.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$9.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$20.09
|
| Rate for Payer: Global Benefits Group Commercial |
$14.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$18.91
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$11.82
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$20.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$8.64
|
| Rate for Payer: United Healthcare HMO Rider |
$8.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Adventist Health Commercial |
$4.73
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$16.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$9.46
|
| Rate for Payer: Galaxy Health WC |
$20.09
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$14.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.55
|
| Rate for Payer: Multiplan Commercial |
$18.91
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$11.82
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$20.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$8.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$20.09
|
|
|
TERBUTALINE 2.5 MG TABLET [11508]
|
Facility
|
IP
|
$5.22
|
|
|
Service Code
|
NDC 0527131801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: Galaxy Health WC |
$4.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.44
|
|
|
TERBUTALINE 2.5 MG TABLET [11508]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 2497913201
|
| 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
|
|
|
TERBUTALINE 2.5 MG TABLET [11508]
|
Facility
|
OP
|
$5.22
|
|
|
Service Code
|
NDC 0527131801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.35
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: Galaxy Health WC |
$4.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.44
|
|
|
TERBUTALINE 2.5 MG TABLET [11508]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 2497913201
|
| 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
|
|
|
TERBUTALINE 5 MG TABLET [11509]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 6255972201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
|
TERBUTALINE 5 MG TABLET [11509]
|
Facility
|
IP
|
$6.38
|
|
|
Service Code
|
NDC 0527131101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4.91
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.47
|
| Rate for Payer: Cigna of CA PPO |
$4.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.42
|
|
|
TERBUTALINE 5 MG TABLET [11509]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 2497913301
|
| 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
|
|
|
TERBUTALINE 5 MG TABLET [11509]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 2497913301
|
| 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
|
|
|
TERBUTALINE 5 MG TABLET [11509]
|
Facility
|
OP
|
$6.38
|
|
|
Service Code
|
NDC 0527131101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.09
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.47
|
| Rate for Payer: Cigna of CA PPO |
$4.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Vantage Medical Group Senior |
$5.42
|
|
|
TERBUTALINE 5 MG TABLET [11509]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 6255972201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
|
TERLIPRESSIN 0.85 MG INTRAVENOUS POWDER FOR SOLUTION [235956]
|
Facility
|
OP
|
$1,256.40
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$1,067.94 |
| Rate for Payer: Adventist Health Commercial |
$251.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$824.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,067.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$691.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$942.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$806.23
|
| Rate for Payer: Cash Price |
$565.38
|
| Rate for Payer: Cigna of CA HMO |
$879.48
|
| Rate for Payer: Cigna of CA PPO |
$879.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,067.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,067.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,067.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$879.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.56
|
| Rate for Payer: EPIC Health Plan Senior |
$502.56
|
| Rate for Payer: Galaxy Health WC |
$1,067.94
|
| Rate for Payer: Global Benefits Group Commercial |
$753.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$797.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$456.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$741.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$879.48
|
| Rate for Payer: Multiplan Commercial |
$1,005.12
|
| Rate for Payer: Networks By Design Commercial |
$628.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,067.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$753.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$753.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$458.96
|
| Rate for Payer: United Healthcare HMO Rider |
$449.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,067.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,067.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1,067.94
|
|
|
TERLIPRESSIN 0.85 MG INTRAVENOUS POWDER FOR SOLUTION [235956]
|
Facility
|
IP
|
$1,256.40
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$1,067.94 |
| Rate for Payer: Cigna of CA PPO |
$879.48
|
| Rate for Payer: Adventist Health Commercial |
$251.28
|
| Rate for Payer: Blue Shield of California Commercial |
$636.99
|
| Rate for Payer: Blue Shield of California Commercial |
$966.17
|
| Rate for Payer: Cash Price |
$565.38
|
| Rate for Payer: Cigna of CA HMO |
$879.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$879.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.56
|
| Rate for Payer: EPIC Health Plan Senior |
$502.56
|
| Rate for Payer: Galaxy Health WC |
$1,067.94
|
| Rate for Payer: Global Benefits Group Commercial |
$753.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$797.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$741.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.54
|
| Rate for Payer: Multiplan Commercial |
$1,005.12
|
| Rate for Payer: Networks By Design Commercial |
$628.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,067.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$458.96
|
| Rate for Payer: United Healthcare HMO Rider |
$449.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.47
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$116,226.28
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$116,226.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,172.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$116,226.28
|
| Rate for Payer: EPIC Health Plan Senior |
$77,484.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70,440.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98,616.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94,389.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$98,763.59
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$98,763.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,338.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$98,763.59
|
| Rate for Payer: EPIC Health Plan Senior |
$65,842.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,856.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83,799.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,208.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL [7783]
|
Facility
|
IP
|
$10.49
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$7.34
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$8.39
|
| Rate for Payer: Networks By Design Commercial |
$5.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.44
|
|
|
TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL [7783]
|
Facility
|
OP
|
$10.49
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$7.34
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$8.39
|
| Rate for Payer: Networks By Design Commercial |
$5.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: Vantage Medical Group Senior |
$8.92
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL [7784]
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Adventist Health Commercial |
$4.45
|
| Rate for Payer: Blue Shield of California Commercial |
$11.28
|
| Rate for Payer: Blue Shield of California Commercial |
$17.11
|
| Rate for Payer: Cash Price |
$10.01
|
| Rate for Payer: Cigna of CA HMO |
$15.57
|
| Rate for Payer: Cigna of CA PPO |
$15.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.90
|
| Rate for Payer: EPIC Health Plan Senior |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$18.91
|
| Rate for Payer: Global Benefits Group Commercial |
$13.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.34
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: Networks By Design Commercial |
$11.12
|
| Rate for Payer: Prime Health Services Commercial |
$18.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.35
|
| Rate for Payer: United Healthcare All Other HMO |
$8.13
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.29
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL [7784]
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Adventist Health Commercial |
$4.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$10.01
|
| Rate for Payer: Cash Price |
$10.01
|
| Rate for Payer: Cigna of CA HMO |
$15.57
|
| Rate for Payer: Cigna of CA PPO |
$15.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.90
|
| Rate for Payer: EPIC Health Plan Senior |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$18.91
|
| Rate for Payer: Global Benefits Group Commercial |
$13.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: Networks By Design Commercial |
$11.12
|
| Rate for Payer: Prime Health Services Commercial |
$18.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.35
|
| Rate for Payer: United Healthcare All Other HMO |
$8.13
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.91
|
| Rate for Payer: Vantage Medical Group Senior |
$18.91
|
|
|
TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE [119618]
|
Facility
|
IP
|
$106.59
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$90.60 |
| Rate for Payer: Adventist Health Commercial |
$21.32
|
| Rate for Payer: Blue Shield of California Commercial |
$54.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Cash Price |
$47.97
|
| Rate for Payer: Cigna of CA HMO |
$74.61
|
| Rate for Payer: Cigna of CA PPO |
$74.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.64
|
| Rate for Payer: Galaxy Health WC |
$90.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.58
|
| Rate for Payer: Multiplan Commercial |
$85.27
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.94
|
| Rate for Payer: United Healthcare HMO Rider |
$38.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.91
|
|
|
TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE [119618]
|
Facility
|
OP
|
$106.59
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$236.10 |
| Rate for Payer: Adventist Health Commercial |
$21.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.02
|
| Rate for Payer: Blue Shield of California Commercial |
$33.59
|
| Rate for Payer: Cash Price |
$47.97
|
| Rate for Payer: Cash Price |
$47.97
|
| Rate for Payer: Cigna of CA HMO |
$74.61
|
| Rate for Payer: Cigna of CA PPO |
$74.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.64
|
| Rate for Payer: Galaxy Health WC |
$90.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.61
|
| Rate for Payer: Multiplan Commercial |
$85.27
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$90.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.94
|
| Rate for Payer: United Healthcare HMO Rider |
$38.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.60
|
| Rate for Payer: Vantage Medical Group Senior |
$90.60
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE [119764]
|
Facility
|
OP
|
$786.79
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$3,621.24 |
| Rate for Payer: Adventist Health Commercial |
$157.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,621.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$654.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$654.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.51
|
| Rate for Payer: Blue Shield of California Commercial |
$779.00
|
| Rate for Payer: Cash Price |
$354.06
|
| Rate for Payer: Cash Price |
$354.06
|
| Rate for Payer: Cigna of CA HMO |
$550.75
|
| Rate for Payer: Cigna of CA PPO |
$550.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$654.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$654.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$981.78
|
| Rate for Payer: EPIC Health Plan Senior |
$654.52
|
| Rate for Payer: Galaxy Health WC |
$668.77
|
| Rate for Payer: Global Benefits Group Commercial |
$472.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$975.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$595.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$595.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,126.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$749.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$797.33
|
| Rate for Payer: Multiplan Commercial |
$629.43
|
| Rate for Payer: Networks By Design Commercial |
$393.39
|
| Rate for Payer: Prime Health Services Commercial |
$668.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.28
|
| Rate for Payer: United Healthcare All Other HMO |
$287.41
|
| Rate for Payer: United Healthcare HMO Rider |
$281.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$595.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$654.52
|
| Rate for Payer: Vantage Medical Group Senior |
$654.52
|
|
