|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$80,189.94
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$64,046.44 |
| Max. Negotiated Rate |
$80,189.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64,046.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80,189.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,748.89
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$22,386.81
|
|
|
Service Code
|
APR-DRG 2331
|
| Min. Negotiated Rate |
$17,879.99 |
| Max. Negotiated Rate |
$22,386.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,879.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,386.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,030.30
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$28,842.10
|
|
|
Service Code
|
APR-DRG 2332
|
| Min. Negotiated Rate |
$23,035.73 |
| Max. Negotiated Rate |
$28,842.10 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,035.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,842.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,806.08
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$41,034.79
|
|
|
Service Code
|
APR-DRG 2333
|
| Min. Negotiated Rate |
$32,773.84 |
| Max. Negotiated Rate |
$41,034.79 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,773.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,034.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,715.34
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$34,351.11
|
|
|
Service Code
|
APR-DRG 2343
|
| Min. Negotiated Rate |
$27,435.69 |
| Max. Negotiated Rate |
$34,351.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,435.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,351.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,735.20
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$18,123.17
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$14,474.69 |
| Max. Negotiated Rate |
$18,123.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,474.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,123.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,215.47
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,118.27
|
|
|
Service Code
|
APR-DRG 2342
|
| Min. Negotiated Rate |
$18,464.20 |
| Max. Negotiated Rate |
$23,118.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,464.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,118.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,684.77
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$71,850.19
|
|
|
Service Code
|
APR-DRG 2344
|
| Min. Negotiated Rate |
$57,385.61 |
| Max. Negotiated Rate |
$71,850.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57,385.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71,850.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,287.01
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$106,108.18
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$106,108.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,886.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$106,108.18
|
| Rate for Payer: EPIC Health Plan Senior |
$70,738.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,307.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90,031.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,172.71
|
| 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
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$121,746.70
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$121,746.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,603.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$121,746.70
|
| Rate for Payer: EPIC Health Plan Senior |
$81,164.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73,785.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103,300.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98,873.08
|
| 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
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$99,562.12
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$99,562.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,702.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,562.12
|
| Rate for Payer: EPIC Health Plan Senior |
$66,374.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,340.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,476.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,856.51
|
| 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
|
|
|
APPLICATION OF CLUBFOOT CAST WITH MOLDING OR MANIPULATION, LONG OR SHORT LEG
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 29450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.08 |
| 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 |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
APRACLONIDINE 0.5 % EYE DROPS [9119]
|
Facility
|
OP
|
$15.42
|
|
|
Service Code
|
NDC 6131466505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.90
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$10.79
|
| Rate for Payer: Cigna of CA PPO |
$10.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.71
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.11
|
|
|
APRACLONIDINE 0.5 % EYE DROPS [9119]
|
Facility
|
IP
|
$15.42
|
|
|
Service Code
|
NDC 6131466505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$10.79
|
| Rate for Payer: Cigna of CA PPO |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
|
|
APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]
|
Facility
|
IP
|
$31.53
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$26.80 |
| Rate for Payer: Cash Price |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$22.07
|
| Rate for Payer: Cigna of CA PPO |
$22.07
|
| Rate for Payer: Adventist Health Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California Commercial |
$24.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.61
|
| Rate for Payer: EPIC Health Plan Senior |
$12.61
|
| Rate for Payer: Galaxy Health WC |
$26.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$25.22
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: Prime Health Services Commercial |
$26.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.52
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
|
|
APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]
|
Facility
|
OP
|
$31.53
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$26.80 |
| Rate for Payer: Adventist Health Commercial |
$6.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Cash Price |
$14.19
|
| Rate for Payer: Cash Price |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$22.07
|
| Rate for Payer: Cigna of CA PPO |
$22.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$26.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$25.22
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: Prime Health Services Commercial |
$26.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.52
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$11.82
|
|
|
Service Code
|
NDC 6340291101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.09
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cigna of CA HMO |
$8.27
|
| Rate for Payer: Cigna of CA PPO |
$8.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$9.46
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 7074817530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 4359877711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 7074817501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 7226625930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$11.82
|
|
|
Service Code
|
NDC 6340291101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.58
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cigna of CA HMO |
$8.27
|
| Rate for Payer: Cigna of CA PPO |
$8.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$9.46
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 4359877711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 7074817530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 4359877730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
