|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 59762-3719-1
|
| Hospital Charge Code |
1730011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 51991-704-01
|
| Hospital Charge Code |
1730011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2027-10
|
| Hospital Charge Code |
1730011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 59762-3720-1
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 65862-677-01
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 65862-677-01
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 59762-3720-1
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 65862-678-01
|
| Hospital Charge Code |
1730117
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 59762-3721-1
|
| Hospital Charge Code |
1730117
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 59762-3721-1
|
| Hospital Charge Code |
1730117
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 65862-678-01
|
| Hospital Charge Code |
1730117
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION [9002]
|
Facility
|
OP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$8,976.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Distinction Transplant |
$6,336.26
|
| Rate for Payer: Blue Shield of California Commercial |
$7,783.04
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO |
$7,392.30
|
| Rate for Payer: Cigna of CA PPO |
$7,392.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: Galaxy Health WC |
$8,976.37
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,920.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,534.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$8,448.34
|
| Rate for Payer: Networks By Design Commercial |
$5,280.22
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,336.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,336.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,280.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5,280.22
|
| Rate for Payer: United Healthcare HMO Rider |
$5,280.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,280.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION [9002]
|
Facility
|
IP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,534.50 |
| Max. Negotiated Rate |
$8,976.37 |
| Rate for Payer: Blue Shield of California Commercial |
$7,519.03
|
| Rate for Payer: Blue Shield of California EPN |
$5,406.94
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO |
$7,392.30
|
| Rate for Payer: Cigna of CA PPO |
$7,392.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,224.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,224.17
|
| Rate for Payer: Galaxy Health WC |
$8,976.37
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,023.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,534.50
|
| Rate for Payer: Multiplan Commercial |
$8,448.34
|
| Rate for Payer: Networks By Design Commercial |
$5,280.22
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,987.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,894.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3,810.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,484.94
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION (ACUTE THROMBOEMBOLIC STROKE) [4081495]
|
Facility
|
OP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$8,976.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Distinction Transplant |
$6,336.26
|
| Rate for Payer: Blue Shield of California Commercial |
$7,783.04
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO |
$7,392.30
|
| Rate for Payer: Cigna of CA PPO |
$7,392.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: Galaxy Health WC |
$8,976.37
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,920.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,534.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$8,448.34
|
| Rate for Payer: Networks By Design Commercial |
$5,280.22
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,336.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,336.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,280.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5,280.22
|
| Rate for Payer: United Healthcare HMO Rider |
$5,280.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,280.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION (ACUTE THROMBOEMBOLIC STROKE) [4081495]
|
Facility
|
IP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,534.50 |
| Max. Negotiated Rate |
$8,976.37 |
| Rate for Payer: Blue Shield of California Commercial |
$7,519.03
|
| Rate for Payer: Blue Shield of California EPN |
$5,406.94
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO |
$7,392.30
|
| Rate for Payer: Cigna of CA PPO |
$7,392.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,224.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,224.17
|
| Rate for Payer: Galaxy Health WC |
$8,976.37
|
| Rate for Payer: Global Benefits Group Commercial |
$6,336.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,043.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,023.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,534.50
|
| Rate for Payer: Multiplan Commercial |
$8,448.34
|
| Rate for Payer: Networks By Design Commercial |
$5,280.22
|
| Rate for Payer: Prime Health Services Commercial |
$8,976.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,987.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,894.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3,810.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,484.94
|
|
|
ALTEPLASE 2 MG INTRA-ARTERIAL SOLUTION FOR NEURO IR [40823708]
|
Facility
|
OP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40823708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$559.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Distinction Transplant |
$120.92
|
| Rate for Payer: Blue Distinction Transplant |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$148.53
|
| Rate for Payer: Blue Shield of California Commercial |
$135.36
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$137.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$100.77
|
| Rate for Payer: United Healthcare HMO Rider |
$91.84
|
| Rate for Payer: United Healthcare HMO Rider |
$100.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 2 MG INTRA-ARTERIAL SOLUTION FOR NEURO IR [40823708]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40823708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$156.12 |
| Rate for Payer: Blue Shield of California Commercial |
$130.77
|
| Rate for Payer: Blue Shield of California Commercial |
$143.50
|
| Rate for Payer: Blue Shield of California EPN |
$94.04
|
| Rate for Payer: Blue Shield of California EPN |
$103.19
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.62
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.10
|
| Rate for Payer: United Healthcare All Other HMO |
$67.74
|
| Rate for Payer: United Healthcare All Other HMO |
$74.33
|
| Rate for Payer: United Healthcare HMO Rider |
$66.27
|
| Rate for Payer: United Healthcare HMO Rider |
$72.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.51
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]
|
Facility
|
OP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$559.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Distinction Transplant |
$120.92
|
| Rate for Payer: Blue Distinction Transplant |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$148.53
|
| Rate for Payer: Blue Shield of California Commercial |
$135.36
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$137.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$100.77
|
| Rate for Payer: United Healthcare HMO Rider |
$91.84
|
| Rate for Payer: United Healthcare HMO Rider |
$100.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$156.12 |
| Rate for Payer: Blue Shield of California Commercial |
$130.77
|
| Rate for Payer: Blue Shield of California Commercial |
$143.50
|
| Rate for Payer: Blue Shield of California EPN |
$94.04
|
| Rate for Payer: Blue Shield of California EPN |
$103.19
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.62
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.10
|
| Rate for Payer: United Healthcare All Other HMO |
$67.74
|
| Rate for Payer: United Healthcare All Other HMO |
$74.33
|
| Rate for Payer: United Healthcare HMO Rider |
$66.27
|
| Rate for Payer: United Healthcare HMO Rider |
$72.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.51
|
|
|
ALTEPLASE (CATHFLO) SYRINGE 2 MG/2 ML FOR NEBULIZATION [4081953]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX4081953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$156.12 |
| Rate for Payer: Blue Shield of California Commercial |
$130.77
|
| Rate for Payer: Blue Shield of California Commercial |
$143.50
|
| Rate for Payer: Blue Shield of California EPN |
$94.04
|
| Rate for Payer: Blue Shield of California EPN |
$103.19
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.62
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.10
|
| Rate for Payer: United Healthcare All Other HMO |
$67.74
|
| Rate for Payer: United Healthcare All Other HMO |
$74.33
|
| Rate for Payer: United Healthcare HMO Rider |
$66.27
|
| Rate for Payer: United Healthcare HMO Rider |
$72.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.51
|
|
|
ALTEPLASE (CATHFLO) SYRINGE 2 MG/2 ML FOR NEBULIZATION [4081953]
|
Facility
|
OP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX4081953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$559.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Distinction Transplant |
$120.92
|
| Rate for Payer: Blue Distinction Transplant |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$148.53
|
| Rate for Payer: Blue Shield of California Commercial |
$135.36
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$137.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$100.77
|
| Rate for Payer: United Healthcare HMO Rider |
$91.84
|
| Rate for Payer: United Healthcare HMO Rider |
$100.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE INTRAVENTRICULAR 2 MG/2 ML SYRINGE [40820125]
|
Facility
|
OP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40820125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$559.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Distinction Transplant |
$120.92
|
| Rate for Payer: Blue Distinction Transplant |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$148.53
|
| Rate for Payer: Blue Shield of California Commercial |
$135.36
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Blue Shield of California EPN |
$91.84
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Media |
$88.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.97
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$137.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$145.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$144.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$91.84
|
| Rate for Payer: United Healthcare All Other HMO |
$100.77
|
| Rate for Payer: United Healthcare HMO Rider |
$91.84
|
| Rate for Payer: United Healthcare HMO Rider |
$100.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE INTRAVENTRICULAR 2 MG/2 ML SYRINGE [40820125]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40820125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$156.12 |
| Rate for Payer: Blue Shield of California Commercial |
$130.77
|
| Rate for Payer: Blue Shield of California Commercial |
$143.50
|
| Rate for Payer: Blue Shield of California EPN |
$94.04
|
| Rate for Payer: Blue Shield of California EPN |
$103.19
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO |
$128.57
|
| Rate for Payer: Cigna of CA HMO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$141.08
|
| Rate for Payer: Cigna of CA PPO |
$128.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.62
|
| Rate for Payer: Galaxy Health WC |
$156.12
|
| Rate for Payer: Galaxy Health WC |
$171.31
|
| Rate for Payer: Global Benefits Group Commercial |
$120.92
|
| Rate for Payer: Global Benefits Group Commercial |
$110.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.37
|
| Rate for Payer: Multiplan Commercial |
$146.94
|
| Rate for Payer: Multiplan Commercial |
$161.23
|
| Rate for Payer: Networks By Design Commercial |
$91.84
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$156.12
|
| Rate for Payer: Prime Health Services Commercial |
$171.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.10
|
| Rate for Payer: United Healthcare All Other HMO |
$67.74
|
| Rate for Payer: United Healthcare All Other HMO |
$74.33
|
| Rate for Payer: United Healthcare HMO Rider |
$66.27
|
| Rate for Payer: United Healthcare HMO Rider |
$72.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.51
|
|
