|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML (0.5%) SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081888]
|
Facility
OP
|
$2.90
|
|
|
Service Code
|
NDC 50383-741-20
|
| Hospital Charge Code |
1744054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: BCBS Transplant Transplant |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Media |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
NDC 73177-146-33
|
| Hospital Charge Code |
1744054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: BCBS Transplant Transplant |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Media |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
NDC 73177-146-33
|
| Hospital Charge Code |
1744054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
OP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: BCBS Transplant Transplant |
$2.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$2.39
|
| Rate for Payer: Cigna of CA PPO |
$2.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.90
|
| Rate for Payer: Dignity Health Media |
$2.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$2.73
|
| Rate for Payer: Networks By Design Commercial |
$2.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
IP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Blue Shield of California Commercial |
$3.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
IP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$2.39
|
| Rate for Payer: Cigna of CA PPO |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$2.73
|
| Rate for Payer: Networks By Design Commercial |
$2.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
OP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: BCBS Transplant Transplant |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$3.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Media |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$5,928.68
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$4,547.92 |
| Max. Negotiated Rate |
$5,928.68 |
| Rate for Payer: IEHP Medi-Cal |
$4,547.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,928.68
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$30,613.46
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$23,483.75 |
| Max. Negotiated Rate |
$30,613.46 |
| Rate for Payer: IEHP Medi-Cal |
$23,483.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,613.46
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$13,820.58
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$10,601.84 |
| Max. Negotiated Rate |
$13,820.58 |
| Rate for Payer: IEHP Medi-Cal |
$10,601.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,820.58
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$8,120.68
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$6,229.41 |
| Max. Negotiated Rate |
$8,120.68 |
| Rate for Payer: IEHP Medi-Cal |
$6,229.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,120.68
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$8,876.17
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$6,808.96 |
| Max. Negotiated Rate |
$8,876.17 |
| Rate for Payer: IEHP Medi-Cal |
$6,808.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,876.17
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$28,698.13
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$22,014.49 |
| Max. Negotiated Rate |
$28,698.13 |
| Rate for Payer: IEHP Medi-Cal |
$22,014.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,698.13
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$10,869.54
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$8,338.08 |
| Max. Negotiated Rate |
$10,869.54 |
| Rate for Payer: IEHP Medi-Cal |
$8,338.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,869.54
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$7,219.75
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$5,538.31 |
| Max. Negotiated Rate |
$7,219.75 |
| Rate for Payer: IEHP Medi-Cal |
$5,538.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,219.75
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$33,387.16
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$25,611.47 |
| Max. Negotiated Rate |
$33,387.16 |
| Rate for Payer: IEHP Medi-Cal |
$25,611.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,387.16
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$10,426.17
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$7,997.97 |
| Max. Negotiated Rate |
$10,426.17 |
| Rate for Payer: IEHP Medi-Cal |
$7,997.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,426.17
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$8,079.88
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$6,198.12 |
| Max. Negotiated Rate |
$8,079.88 |
| Rate for Payer: IEHP Medi-Cal |
$6,198.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,079.88
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$15,874.23
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$12,177.21 |
| Max. Negotiated Rate |
$15,874.23 |
| Rate for Payer: IEHP Medi-Cal |
$12,177.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,874.23
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
IP
|
$87.45
|
|
|
Service Code
|
NDC 50242-130-01
|
| Hospital Charge Code |
ERX212384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Blue Shield of California Commercial |
$62.26
|
| Rate for Payer: Blue Shield of California EPN |
$44.77
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cigna of CA HMO |
$61.22
|
| Rate for Payer: Cigna of CA PPO |
$61.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.98
|
| Rate for Payer: Galaxy Health WC |
$74.33
|
| Rate for Payer: Global Benefits Group Commercial |
$52.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.99
|
| Rate for Payer: Multiplan Commercial |
$69.96
|
| Rate for Payer: Networks By Design Commercial |
$56.84
|
| Rate for Payer: Prime Health Services Commercial |
$74.33
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
OP
|
$87.45
|
|
|
Service Code
|
NDC 50242-130-01
|
| Hospital Charge Code |
ERX212384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.10
|
| Rate for Payer: BCBS Transplant Transplant |
$52.47
|
| Rate for Payer: Blue Shield of California Commercial |
$64.45
|
| Rate for Payer: Blue Shield of California EPN |
$51.07
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cigna of CA HMO |
$61.22
|
| Rate for Payer: Cigna of CA PPO |
$61.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.33
|
| Rate for Payer: Dignity Health Media |
$74.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.98
|
| Rate for Payer: Galaxy Health WC |
$74.33
|
| Rate for Payer: Global Benefits Group Commercial |
$52.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.99
|
| Rate for Payer: Multiplan Commercial |
$69.96
|
| Rate for Payer: Networks By Design Commercial |
$56.84
|
| Rate for Payer: Prime Health Services Commercial |
$74.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$52.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.72
|
| Rate for Payer: United Healthcare All Other HMO |
$43.72
|
| Rate for Payer: United Healthcare HMO Rider |
$43.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.33
|
| Rate for Payer: Vantage Medical Group Senior |
$74.33
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
OP
|
$28,798.18
|
|
|
Service Code
|
CPT J0202
|
| Hospital Charge Code |
NDG208005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,324.34 |
| Max. Negotiated Rate |
$24,478.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,618.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,905.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,556.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,556.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,508.09
|
| Rate for Payer: BCBS Transplant Transplant |
$17,278.91
|
| Rate for Payer: Blue Shield of California Commercial |
$21,224.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,463.46
|
| Rate for Payer: Cash Price |
$12,959.18
|
| Rate for Payer: Cash Price |
$12,959.18
|
| Rate for Payer: Cigna of CA HMO |
$20,158.73
|
| Rate for Payer: Cigna of CA PPO |
$20,158.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.52
|
| Rate for Payer: Dignity Health Media |
$2,324.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,324.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,324.34
|
| Rate for Payer: Galaxy Health WC |
$24,478.45
|
| Rate for Payer: Global Benefits Group Commercial |
$17,278.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,598.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,811.92
|
| Rate for Payer: IEHP Medi-Cal |
$3,765.44
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,765.44
|
| Rate for Payer: IEHP Medicare Advantage |
$2,324.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,208.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,424.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,911.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.62
|
| Rate for Payer: Multiplan Commercial |
$23,038.54
|
| Rate for Payer: Networks By Design Commercial |
$14,399.09
|
| Rate for Payer: Prime Health Services Commercial |
$24,478.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,278.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,278.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,399.09
|
| Rate for Payer: United Healthcare All Other HMO |
$14,399.09
|
| Rate for Payer: United Healthcare HMO Rider |
$14,399.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,399.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.78
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.34
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
IP
|
$28,798.18
|
|
|
Service Code
|
CPT J0202
|
| Hospital Charge Code |
NDG208005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,911.56 |
| Max. Negotiated Rate |
$24,478.45 |
| Rate for Payer: Blue Shield of California Commercial |
$20,504.30
|
| Rate for Payer: Blue Shield of California EPN |
$14,744.67
|
| Rate for Payer: Cash Price |
$12,959.18
|
| Rate for Payer: Cigna of CA HMO |
$20,158.73
|
| Rate for Payer: Cigna of CA PPO |
$20,158.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,519.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,519.27
|
| Rate for Payer: Galaxy Health WC |
$24,478.45
|
| Rate for Payer: Global Benefits Group Commercial |
$17,278.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,208.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,972.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,911.56
|
| Rate for Payer: Multiplan Commercial |
$23,038.54
|
| Rate for Payer: Networks By Design Commercial |
$14,399.09
|
| Rate for Payer: Prime Health Services Commercial |
$24,478.45
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 64980-340-03
|
| Hospital Charge Code |
1711759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| 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 Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| 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 64980-340-03
|
| Hospital Charge Code |
1711759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| 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: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| 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
|
|
