|
ADAGRASIB 200 MG TABLET [236395]
|
Facility
|
IP
|
$153.63
|
|
|
Service Code
|
NDC 8073981218
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$130.59 |
| Rate for Payer: Adventist Health Commercial |
$30.73
|
| Rate for Payer: Blue Shield of California Commercial |
$118.14
|
| Rate for Payer: Blue Shield of California Commercial |
$77.89
|
| Rate for Payer: Cash Price |
$69.13
|
| Rate for Payer: Cigna of CA HMO |
$107.54
|
| Rate for Payer: Cigna of CA PPO |
$107.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.45
|
| Rate for Payer: EPIC Health Plan Senior |
$61.45
|
| Rate for Payer: Galaxy Health WC |
$130.59
|
| Rate for Payer: Global Benefits Group Commercial |
$92.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.87
|
| Rate for Payer: Multiplan Commercial |
$122.90
|
| Rate for Payer: Networks By Design Commercial |
$99.86
|
| Rate for Payer: Prime Health Services Commercial |
$130.59
|
|
|
ADAGRASIB 200 MG TABLET [236395]
|
Facility
|
OP
|
$153.63
|
|
|
Service Code
|
NDC 8073981218
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$130.59 |
| Rate for Payer: Adventist Health Commercial |
$30.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.58
|
| Rate for Payer: Cash Price |
$69.13
|
| Rate for Payer: Cigna of CA HMO |
$107.54
|
| Rate for Payer: Cigna of CA PPO |
$107.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.45
|
| Rate for Payer: EPIC Health Plan Senior |
$61.45
|
| Rate for Payer: Galaxy Health WC |
$130.59
|
| Rate for Payer: Global Benefits Group Commercial |
$92.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.54
|
| Rate for Payer: Multiplan Commercial |
$122.90
|
| Rate for Payer: Networks By Design Commercial |
$99.86
|
| Rate for Payer: Prime Health Services Commercial |
$130.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.81
|
| Rate for Payer: United Healthcare HMO Rider |
$76.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.59
|
| Rate for Payer: Vantage Medical Group Senior |
$130.59
|
|
|
ADAPALENE 0.1 % TOPICAL CREAM [21831]
|
Facility
|
IP
|
$6.03
|
|
|
Service Code
|
NDC 4580245384
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Senior |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
ADAPALENE 0.1 % TOPICAL CREAM [21831]
|
Facility
|
OP
|
$6.03
|
|
|
Service Code
|
NDC 4580245384
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: EPIC Health Plan Senior |
$2.41
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.87
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 42831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$198.27 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$198.27 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [39477]
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [39477]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.58
|
|
|
ADENOSINE 6 MG/2 ML VIAL - CODE [4080560]
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.58
|
|
|
ADENOSINE 6 MG/2 ML VIAL - CODE [4080560]
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]
|
Facility
|
IP
|
$5.72
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$2.69
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$3.10
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$4.86
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$3.07
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]
|
Facility
|
OP
|
$7.15
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Cigna of CA HMO |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$2.69
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.29
|
| Rate for Payer: EPIC Health Plan Senior |
$3.10
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$3.07
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6.08
|
| Rate for Payer: Vantage Medical Group Senior |
$3.26
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$10,340.84
|
|
|
Service Code
|
APR-DRG 7553
|
| Min. Negotiated Rate |
$8,259.07 |
| Max. Negotiated Rate |
$10,340.84 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,259.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,340.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,252.33
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$5,579.31
|
|
|
Service Code
|
APR-DRG 7552
|
| Min. Negotiated Rate |
$4,456.11 |
| Max. Negotiated Rate |
$5,579.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,456.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,579.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,992.02
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$4,143.20
|
|
|
Service Code
|
APR-DRG 7551
|
| Min. Negotiated Rate |
$3,309.11 |
| Max. Negotiated Rate |
$4,143.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,309.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,143.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,707.07
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$16,413.62
|
|
|
Service Code
|
APR-DRG 7554
|
| Min. Negotiated Rate |
$13,109.30 |
| Max. Negotiated Rate |
$16,413.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,109.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,413.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,685.88
|
|
|
ADJUVANT AS01B (PF), COMPONENT VIAL 1 OF 2 INTRAMUSCULAR SUSPENSION [219987]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 5816082903
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
ADJUVANT AS01B (PF), COMPONENT VIAL 1 OF 2 INTRAMUSCULAR SUSPENSION [219987]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 5816082903
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
|
IP
|
$4,979.06
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$995.81 |
| Max. Negotiated Rate |
$4,232.20 |
| Rate for Payer: Adventist Health Commercial |
$995.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,524.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3,828.90
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Cigna of CA HMO |
$3,485.34
|
| Rate for Payer: Cigna of CA PPO |
$3,485.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,485.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,991.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1,991.62
|
| Rate for Payer: Galaxy Health WC |
$4,232.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,987.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,161.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,937.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.97
|
| Rate for Payer: Multiplan Commercial |
$3,983.25
|
| Rate for Payer: Networks By Design Commercial |
$2,489.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,818.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.64
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
|
OP
|
$4,979.06
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$4,232.20 |
| Rate for Payer: Adventist Health Commercial |
$995.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.87
|
| Rate for Payer: Blue Shield of California Commercial |
$47.17
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Cigna of CA HMO |
$3,485.34
|
| Rate for Payer: Cigna of CA PPO |
$3,485.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,485.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.99
|
| Rate for Payer: EPIC Health Plan Senior |
$47.99
|
| Rate for Payer: Galaxy Health WC |
$4,232.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,987.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,161.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$3,983.25
|
| Rate for Payer: Networks By Design Commercial |
$2,489.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,232.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,987.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,987.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,818.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Vantage Medical Group Senior |
$47.99
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
|
OP
|
$7,966.49
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$6,771.52 |
| Rate for Payer: Adventist Health Commercial |
$1,593.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.87
|
| Rate for Payer: Blue Shield of California Commercial |
$47.17
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Cigna of CA HMO |
$5,576.54
|
| Rate for Payer: Cigna of CA PPO |
$5,576.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,576.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.99
|
| Rate for Payer: EPIC Health Plan Senior |
$47.99
|
| Rate for Payer: Galaxy Health WC |
$6,771.52
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,058.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$6,373.19
|
| Rate for Payer: Networks By Design Commercial |
$3,983.24
|
| Rate for Payer: Prime Health Services Commercial |
$6,771.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,779.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,779.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,989.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2,910.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2,847.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,609.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Vantage Medical Group Senior |
$47.99
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
|
IP
|
$7,966.49
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,593.30 |
| Max. Negotiated Rate |
$6,771.52 |
| Rate for Payer: Adventist Health Commercial |
$1,593.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,039.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6,126.23
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Cigna of CA HMO |
$5,576.54
|
| Rate for Payer: Cigna of CA PPO |
$5,576.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,576.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,186.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,186.60
|
| Rate for Payer: Galaxy Health WC |
$6,771.52
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,058.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,700.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.96
|
| Rate for Payer: Multiplan Commercial |
$6,373.19
|
| Rate for Payer: Networks By Design Commercial |
$3,983.24
|
| Rate for Payer: Prime Health Services Commercial |
$6,771.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,989.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2,910.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2,847.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,609.03
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$118,142.72
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$118,142.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,446.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$118,142.72
|
| Rate for Payer: EPIC Health Plan Senior |
$78,761.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,601.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100,242.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95,946.21
|
| 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
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$104,079.95
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$104,079.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,421.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,079.95
|
| Rate for Payer: EPIC Health Plan Senior |
$69,386.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,078.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,310.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,525.54
|
| 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
|
|
