|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$13,035.84
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$10,411.52 |
| Max. Negotiated Rate |
$13,035.84 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,411.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,035.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,663.65
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$7,327.62
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$5,852.45 |
| Max. Negotiated Rate |
$7,327.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,852.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,327.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,556.29
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$90,196.38
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$90,196.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,701.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,196.38
|
| Rate for Payer: EPIC Health Plan Senior |
$60,130.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,664.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,530.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,250.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$110,216.11
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$110,216.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,904.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,216.11
|
| Rate for Payer: EPIC Health Plan Senior |
$73,477.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,797.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93,516.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,508.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$94,914.75
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$94,914.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,762.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,914.75
|
| Rate for Payer: EPIC Health Plan Senior |
$63,276.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,524.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,533.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,082.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$104,369.20
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$104,369.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,915.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69,579.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,254.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,555.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,760.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$63,968.67
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$51,090.77 |
| Max. Negotiated Rate |
$63,968.67 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51,090.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63,968.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57,235.12
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$25,018.95
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$19,982.24 |
| Max. Negotiated Rate |
$25,018.95 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,982.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,018.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,385.38
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$16,456.34
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$13,143.42 |
| Max. Negotiated Rate |
$16,456.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,143.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,456.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,724.09
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$12,521.72
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$10,000.90 |
| Max. Negotiated Rate |
$12,521.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,000.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,521.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,203.65
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
IP
|
$102.20
|
|
|
Service Code
|
NDC 5024213001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$86.87 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Blue Shield of California Commercial |
$51.82
|
| Rate for Payer: Blue Shield of California Commercial |
$78.59
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: Cigna of CA HMO |
$71.54
|
| Rate for Payer: Cigna of CA PPO |
$71.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.88
|
| Rate for Payer: EPIC Health Plan Senior |
$40.88
|
| Rate for Payer: Galaxy Health WC |
$86.87
|
| Rate for Payer: Global Benefits Group Commercial |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.53
|
| Rate for Payer: Multiplan Commercial |
$81.76
|
| Rate for Payer: Networks By Design Commercial |
$66.43
|
| Rate for Payer: Prime Health Services Commercial |
$86.87
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
NDC 5024213001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$86.87 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.58
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: Cigna of CA HMO |
$71.54
|
| Rate for Payer: Cigna of CA PPO |
$71.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.88
|
| Rate for Payer: EPIC Health Plan Senior |
$40.88
|
| Rate for Payer: Galaxy Health WC |
$86.87
|
| Rate for Payer: Global Benefits Group Commercial |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.54
|
| Rate for Payer: Multiplan Commercial |
$81.76
|
| Rate for Payer: Networks By Design Commercial |
$66.43
|
| Rate for Payer: Prime Health Services Commercial |
$86.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.10
|
| Rate for Payer: United Healthcare All Other HMO |
$51.10
|
| Rate for Payer: United Healthcare HMO Rider |
$51.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.87
|
| Rate for Payer: Vantage Medical Group Senior |
$86.87
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
IP
|
$30,041.68
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,008.34 |
| Max. Negotiated Rate |
$25,535.43 |
| Rate for Payer: Adventist Health Commercial |
$6,008.34
|
| Rate for Payer: Blue Shield of California Commercial |
$15,231.13
|
| Rate for Payer: Blue Shield of California Commercial |
$23,102.05
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cigna of CA HMO |
$21,029.18
|
| Rate for Payer: Cigna of CA PPO |
$21,029.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,029.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,016.67
|
| Rate for Payer: EPIC Health Plan Senior |
$12,016.67
|
| Rate for Payer: Galaxy Health WC |
$25,535.43
|
| Rate for Payer: Global Benefits Group Commercial |
$18,025.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,076.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,724.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,210.00
|
| Rate for Payer: Multiplan Commercial |
$24,033.34
|
| Rate for Payer: Networks By Design Commercial |
$15,020.84
|
| Rate for Payer: Prime Health Services Commercial |
$25,535.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,274.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10,974.23
|
| Rate for Payer: United Healthcare HMO Rider |
$10,736.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,838.65
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
OP
|
$30,041.68
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,544.94 |
| Max. Negotiated Rate |
$25,535.43 |
| Rate for Payer: Adventist Health Commercial |
$6,008.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,355.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,799.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,204.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,915.82
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cigna of CA HMO |
$21,029.18
|
| Rate for Payer: Cigna of CA PPO |
$21,029.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,799.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,029.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$2,799.43
|
| Rate for Payer: Galaxy Health WC |
$25,535.43
|
| Rate for Payer: Global Benefits Group Commercial |
$18,025.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,544.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,076.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,649.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,562.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.22
|
| Rate for Payer: Multiplan Commercial |
$24,033.34
|
| Rate for Payer: Networks By Design Commercial |
$15,020.84
|
| Rate for Payer: Prime Health Services Commercial |
$25,535.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,025.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,025.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,274.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10,974.23
|
| Rate for Payer: United Healthcare HMO Rider |
$10,736.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,838.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,544.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2,799.43
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 6498034003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 6498034003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
NDC 0054028259
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
NDC 0054028259
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 6586232904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
NDC 6586232904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
IP
|
$0.75
|
|
|
Service Code
|
NDC 6498034214
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 6498034214
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 4733595688
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 4733595688
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]
|
Facility
|
IP
|
$1,215.88
|
|
|
Service Code
|
HCPCS J0221
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.18 |
| Max. Negotiated Rate |
$1,033.50 |
| Rate for Payer: Cigna of CA HMO |
$851.12
|
| Rate for Payer: Cigna of CA PPO |
$851.12
|
| Rate for Payer: Adventist Health Commercial |
$243.18
|
| Rate for Payer: Blue Shield of California Commercial |
$616.45
|
| Rate for Payer: Blue Shield of California Commercial |
$935.01
|
| Rate for Payer: Cash Price |
$547.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.35
|
| Rate for Payer: EPIC Health Plan Senior |
$486.35
|
| Rate for Payer: Galaxy Health WC |
$1,033.50
|
| Rate for Payer: Global Benefits Group Commercial |
$729.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$717.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.81
|
| Rate for Payer: Multiplan Commercial |
$972.70
|
| Rate for Payer: Networks By Design Commercial |
$607.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.32
|
| Rate for Payer: United Healthcare All Other HMO |
$444.16
|
| Rate for Payer: United Healthcare HMO Rider |
$434.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.20
|
|
