|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]
|
Facility
|
OP
|
$1,215.88
|
|
|
Service Code
|
HCPCS J0221
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.13 |
| Max. Negotiated Rate |
$1,267.73 |
| Rate for Payer: Adventist Health Commercial |
$243.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.68
|
| Rate for Payer: Blue Shield of California Commercial |
$231.46
|
| Rate for Payer: Cash Price |
$547.15
|
| Rate for Payer: Cash Price |
$547.15
|
| Rate for Payer: Cigna of CA HMO |
$851.12
|
| Rate for Payer: Cigna of CA PPO |
$851.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.36
|
| Rate for Payer: EPIC Health Plan Senior |
$232.24
|
| Rate for Payer: Galaxy Health WC |
$1,033.50
|
| Rate for Payer: Global Benefits Group Commercial |
$729.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$346.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$211.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.91
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$729.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$729.53
|
| 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
|
| Rate for Payer: Upland Medical Group Pediatric |
$211.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.24
|
| Rate for Payer: Vantage Medical Group Senior |
$232.24
|
|
|
ALISKIREN 150 MG TABLET [78653]
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 7083915030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Adventist Health Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California Commercial |
$11.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cigna of CA HMO |
$10.54
|
| Rate for Payer: Cigna of CA PPO |
$10.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.02
|
| Rate for Payer: Galaxy Health WC |
$12.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$9.79
|
| Rate for Payer: Prime Health Services Commercial |
$12.80
|
|
|
ALISKIREN 150 MG TABLET [78653]
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
NDC 7083915030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Adventist Health Commercial |
$3.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cigna of CA HMO |
$10.54
|
| Rate for Payer: Cigna of CA PPO |
$10.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.02
|
| Rate for Payer: Galaxy Health WC |
$12.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.54
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$9.79
|
| Rate for Payer: Prime Health Services Commercial |
$12.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12.80
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$50,415.68
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$40,266.21 |
| Max. Negotiated Rate |
$50,415.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,266.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50,415.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,108.77
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$10,471.47
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$8,363.40 |
| Max. Negotiated Rate |
$10,471.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,363.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,471.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,369.21
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$7,257.43
|
|
|
Service Code
|
APR-DRG 8111
|
| Min. Negotiated Rate |
$5,796.39 |
| Max. Negotiated Rate |
$7,257.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,796.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,257.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,493.49
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$20,581.29
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$16,437.95 |
| Max. Negotiated Rate |
$20,581.29 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,437.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,581.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,414.84
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$109,089.32
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$109,089.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,979.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,089.32
|
| Rate for Payer: EPIC Health Plan Senior |
$72,726.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,114.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,560.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,593.75
|
| 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
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$91,073.00
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,073.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,199.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,073.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60,715.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,195.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,274.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,962.32
|
| 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
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$364,334.66
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$165,000.00 |
| Max. Negotiated Rate |
$364,334.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364,334.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$292,505.17
|
| Rate for Payer: EPIC Health Plan Senior |
$195,003.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$165,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248,186.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237,549.65
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$141,869.28
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$113,308.75 |
| Max. Negotiated Rate |
$141,869.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113,308.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141,869.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126,935.67
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$228,985.61
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$182,887.19 |
| Max. Negotiated Rate |
$228,985.61 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182,887.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228,985.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204,881.86
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$170,434.01
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$136,122.95 |
| Max. Negotiated Rate |
$170,434.01 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136,122.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170,434.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152,493.59
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$498,203.35
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$397,907.15 |
| Max. Negotiated Rate |
$498,203.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$397,907.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$498,203.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$445,760.89
|
|
|
Allogenic Related Transplant
|
Facility
|
IP
|
$209,440.00
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$209,440.00 |
| Max. Negotiated Rate |
$209,440.00 |
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$209,440.00
|
|
|
Allogenic Unrelated Transplant
|
Facility
|
IP
|
$229,075.00
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$229,075.00 |
| Max. Negotiated Rate |
$229,075.00 |
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$229,075.00
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 0378013701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 2930034901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 5107920520
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0603211521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0603211521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 5107920501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 0378013701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 5107920520
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
ALLOPURINOL 100 MG TABLET [310]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5348915601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
