|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
OP
|
$108.87
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
1712538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Distinction Transplant |
$65.32
|
| Rate for Payer: Blue Shield of California Commercial |
$80.24
|
| Rate for Payer: Blue Shield of California EPN |
$63.58
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cigna of CA HMO |
$76.21
|
| Rate for Payer: Cigna of CA PPO |
$76.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.54
|
| Rate for Payer: Dignity Health Media |
$92.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.55
|
| Rate for Payer: Galaxy Health WC |
$92.54
|
| Rate for Payer: Global Benefits Group Commercial |
$65.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$81.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.13
|
| Rate for Payer: Multiplan Commercial |
$87.10
|
| Rate for Payer: Networks By Design Commercial |
$70.77
|
| Rate for Payer: Prime Health Services Commercial |
$92.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.44
|
| Rate for Payer: United Healthcare All Other HMO |
$54.44
|
| Rate for Payer: United Healthcare HMO Rider |
$54.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.54
|
| Rate for Payer: Vantage Medical Group Senior |
$92.54
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 30802
|
| Min. Negotiated Rate |
$155.63 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,086.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,086.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 30801
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,086.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,086.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
OP
|
$618.60
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX106761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$525.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.20
|
| Rate for Payer: Blue Distinction Transplant |
$371.16
|
| Rate for Payer: Blue Shield of California Commercial |
$455.91
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cigna of CA HMO |
$433.02
|
| Rate for Payer: Cigna of CA PPO |
$433.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Media |
$8.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$525.81
|
| Rate for Payer: Global Benefits Group Commercial |
$371.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$463.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.44
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$494.88
|
| Rate for Payer: Networks By Design Commercial |
$309.30
|
| Rate for Payer: Prime Health Services Commercial |
$525.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$371.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$309.30
|
| Rate for Payer: United Healthcare All Other HMO |
$309.30
|
| Rate for Payer: United Healthcare HMO Rider |
$309.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
IP
|
$618.60
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX106761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$525.81 |
| Rate for Payer: Blue Shield of California Commercial |
$440.44
|
| Rate for Payer: Blue Shield of California EPN |
$316.72
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cigna of CA HMO |
$433.02
|
| Rate for Payer: Cigna of CA PPO |
$433.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.44
|
| Rate for Payer: Galaxy Health WC |
$525.81
|
| Rate for Payer: Global Benefits Group Commercial |
$371.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.46
|
| Rate for Payer: Multiplan Commercial |
$494.88
|
| Rate for Payer: Networks By Design Commercial |
$309.30
|
| Rate for Payer: Prime Health Services Commercial |
$525.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.58
|
| Rate for Payer: United Healthcare All Other HMO |
$228.14
|
| Rate for Payer: United Healthcare HMO Rider |
$223.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.14
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
|
IP
|
$1,030.80
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX99465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$247.39 |
| Max. Negotiated Rate |
$876.18 |
| Rate for Payer: Blue Shield of California Commercial |
$733.93
|
| Rate for Payer: Blue Shield of California EPN |
$527.77
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cigna of CA HMO |
$721.56
|
| Rate for Payer: Cigna of CA PPO |
$721.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$412.32
|
| Rate for Payer: Galaxy Health WC |
$876.18
|
| Rate for Payer: Global Benefits Group Commercial |
$618.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.39
|
| Rate for Payer: Multiplan Commercial |
$824.64
|
| Rate for Payer: Networks By Design Commercial |
$515.40
|
| Rate for Payer: Prime Health Services Commercial |
$876.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.23
|
| Rate for Payer: United Healthcare All Other HMO |
$380.16
|
| Rate for Payer: United Healthcare HMO Rider |
$371.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.16
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
|
OP
|
$1,030.80
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX99465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$876.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.20
|
| Rate for Payer: Blue Distinction Transplant |
$618.48
|
| Rate for Payer: Blue Shield of California Commercial |
$759.70
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cigna of CA HMO |
$721.56
|
| Rate for Payer: Cigna of CA PPO |
$721.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Media |
$8.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$876.18
|
| Rate for Payer: Global Benefits Group Commercial |
$618.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$773.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.44
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$824.64
|
| Rate for Payer: Networks By Design Commercial |
$515.40
|
| Rate for Payer: Prime Health Services Commercial |
$876.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.40
|
| Rate for Payer: United Healthcare All Other HMO |
$515.40
|
| Rate for Payer: United Healthcare HMO Rider |
$515.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$515.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$9,855.11
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$7,559.91 |
| Max. Negotiated Rate |
$9,855.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,559.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,855.11
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$39,790.60
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$30,523.58 |
| Max. Negotiated Rate |
$39,790.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,523.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,790.60
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$7,444.98
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$5,711.08 |
| Max. Negotiated Rate |
$7,444.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,711.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,444.98
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$13,325.78
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$10,222.28 |
| Max. Negotiated Rate |
$13,325.78 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,222.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,325.78
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,359.62
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$4,878.50 |
| Max. Negotiated Rate |
$6,359.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,878.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,359.62
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$8,877.94
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$6,810.31 |
| Max. Negotiated Rate |
$8,877.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,810.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,877.94
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$4,754.66
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$3,647.32 |
| Max. Negotiated Rate |
$4,754.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,647.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,754.66
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$25,692.12
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$19,708.56 |
| Max. Negotiated Rate |
$25,692.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,708.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,692.12
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
1711694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Distinction Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Media |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
1711694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
1753544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Distinction Transplant |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Media |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
1753544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Distinction Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Media |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
ACETAMINOPHEN 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE [4080108021]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
|
|
ACETAMINOPHEN 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE [4080108021]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Distinction Transplant |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Media |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION [199408]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 0121-0504-00
|
| Hospital Charge Code |
1717108
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION [199408]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 0121-0504-05
|
| Hospital Charge Code |
1717108
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
