|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
HCPCS J0463
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1.83
|
| Rate for Payer: Galaxy Health WC |
$3.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.66
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Prime Health Services Commercial |
$3.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: Vantage Medical Group Senior |
$3.89
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
HCPCS J0463
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1.83
|
| Rate for Payer: Galaxy Health WC |
$3.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.66
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Prime Health Services Commercial |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]
|
Facility
|
IP
|
$13.92
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$11.83 |
| Rate for Payer: Adventist Health Commercial |
$2.78
|
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9.82
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6.47
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cigna of CA HMO |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$8.94
|
| Rate for Payer: Cigna of CA PPO |
$8.94
|
| Rate for Payer: Cigna of CA PPO |
$9.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$11.83
|
| Rate for Payer: Global Benefits Group Commercial |
$8.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cigna of CA HMO |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$8.94
|
| Rate for Payer: Cigna of CA PPO |
$9.74
|
| Rate for Payer: Cigna of CA PPO |
$8.94
|
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Adventist Health Commercial |
$2.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: Galaxy Health WC |
$11.83
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.74
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Networks By Design Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO |
$5.08
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.83
|
| Rate for Payer: Vantage Medical Group Senior |
$10.85
|
| Rate for Payer: Vantage Medical Group Senior |
$11.83
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.17
|
| Rate for Payer: Vantage Medical Group Senior |
$1.16
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
NDC 0065081701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.33 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.31
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.25
|
| Rate for Payer: United Healthcare All Other HMO |
$7.25
|
| Rate for Payer: United Healthcare HMO Rider |
$7.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
NDC 0065081701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.33 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.16
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
OP
|
$21.54
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$18.31 |
| Rate for Payer: Cigna of CA PPO |
$14.32
|
| Rate for Payer: Cigna of CA PPO |
$15.27
|
| Rate for Payer: Cigna of CA PPO |
$15.08
|
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Adventist Health Commercial |
$4.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.36
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cigna of CA HMO |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$15.08
|
| Rate for Payer: Cigna of CA HMO |
$15.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$8.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Senior |
$8.73
|
| Rate for Payer: Galaxy Health WC |
$18.55
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Galaxy Health WC |
$17.39
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.28
|
| Rate for Payer: Global Benefits Group Commercial |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.32
|
| Rate for Payer: Multiplan Commercial |
$16.37
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Multiplan Commercial |
$17.46
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Prime Health Services Commercial |
$17.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.55
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7.97
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$17.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.31
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
IP
|
$20.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Adventist Health Commercial |
$4.09
|
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California Commercial |
$16.56
|
| Rate for Payer: Blue Shield of California Commercial |
$10.37
|
| Rate for Payer: Blue Shield of California Commercial |
$15.73
|
| Rate for Payer: Blue Shield of California Commercial |
$16.78
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$10.92
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cigna of CA HMO |
$15.27
|
| Rate for Payer: Cigna of CA HMO |
$15.08
|
| Rate for Payer: Cigna of CA HMO |
$14.32
|
| Rate for Payer: Cigna of CA PPO |
$14.32
|
| Rate for Payer: Cigna of CA PPO |
$15.27
|
| Rate for Payer: Cigna of CA PPO |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Senior |
$8.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8.73
|
| Rate for Payer: Galaxy Health WC |
$18.55
|
| Rate for Payer: Galaxy Health WC |
$17.39
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.28
|
| Rate for Payer: Global Benefits Group Commercial |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$16.37
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Multiplan Commercial |
$17.46
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$18.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.19
|
| Rate for Payer: United Healthcare All Other HMO |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.70
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.05
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$74,831.20
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$59,766.49 |
| Max. Negotiated Rate |
$74,831.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59,766.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74,831.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66,954.23
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$88,652.65
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$70,805.47 |
| Max. Negotiated Rate |
$88,652.65 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70,805.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88,652.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,320.79
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$109,538.50
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$87,486.67 |
| Max. Negotiated Rate |
$109,538.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87,486.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109,538.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98,008.13
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$216,484.63
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$172,902.86 |
| Max. Negotiated Rate |
$216,484.63 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172,902.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216,484.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193,696.78
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$184,471.11
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$90,244.00 |
| Max. Negotiated Rate |
$184,471.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$179,764.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$184,471.11
|
| Rate for Payer: EPIC Health Plan Senior |
$122,980.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156,520.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149,812.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$157,080.00
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$175,644.84
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$90,244.00 |
| Max. Negotiated Rate |
$175,644.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146,677.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$175,644.84
|
| Rate for Payer: EPIC Health Plan Senior |
$117,096.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149,031.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142,644.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$157,080.00
|
|
|
AVACINCAPTAD PEGOL (PF) 2 MG/0.1 ML INTRAVITREAL SOLUTION [239150]
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
HCPCS J2782
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,040.00 |
| Max. Negotiated Rate |
$21,420.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,776.40
|
| Rate for Payer: Blue Shield of California Commercial |
$19,378.80
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cigna of CA HMO |
$17,640.00
|
| Rate for Payer: Cigna of CA PPO |
$17,640.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,080.00
|
| Rate for Payer: Galaxy Health WC |
$21,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,002.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,868.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,048.00
|
| Rate for Payer: Multiplan Commercial |
$20,160.00
|
| Rate for Payer: Networks By Design Commercial |
$12,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,457.56
|
| Rate for Payer: United Healthcare All Other HMO |
$9,205.56
|
| Rate for Payer: United Healthcare HMO Rider |
$9,006.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,253.00
|
|
|
AVACINCAPTAD PEGOL (PF) 2 MG/0.1 ML INTRAVITREAL SOLUTION [239150]
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
HCPCS J2782
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$21,420.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$675.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.26
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cigna of CA HMO |
$17,640.00
|
| Rate for Payer: Cigna of CA PPO |
$17,640.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.28
|
| Rate for Payer: EPIC Health Plan Senior |
$113.52
|
| Rate for Payer: Galaxy Health WC |
$21,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,120.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$169.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,002.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,048.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.29
|
| Rate for Payer: Multiplan Commercial |
$20,160.00
|
| Rate for Payer: Networks By Design Commercial |
$12,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,420.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,457.56
|
| Rate for Payer: United Healthcare All Other HMO |
$9,205.56
|
| Rate for Payer: United Healthcare HMO Rider |
$9,006.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,253.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$103.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.52
|
| Rate for Payer: Vantage Medical Group Senior |
$113.52
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION [232506]
|
Facility
|
OP
|
$2,431.75
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.94 |
| Max. Negotiated Rate |
$2,066.99 |
| Rate for Payer: Adventist Health Commercial |
$486.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$489.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.20
|
| Rate for Payer: Blue Shield of California Commercial |
$89.02
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cigna of CA HMO |
$1,702.22
|
| Rate for Payer: Cigna of CA PPO |
$1,702.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,702.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.52
|
| Rate for Payer: EPIC Health Plan Senior |
$92.34
|
| Rate for Payer: Galaxy Health WC |
$2,066.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$137.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,544.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.49
|
| Rate for Payer: Multiplan Commercial |
$1,945.40
|
| Rate for Payer: Networks By Design Commercial |
$1,215.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,066.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$912.64
|
| Rate for Payer: United Healthcare All Other HMO |
$888.32
|
| Rate for Payer: United Healthcare HMO Rider |
$869.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$796.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$83.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION [232506]
|
Facility
|
IP
|
$2,431.75
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$486.35 |
| Max. Negotiated Rate |
$2,066.99 |
| Rate for Payer: Adventist Health Commercial |
$486.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,232.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.02
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cigna of CA HMO |
$1,702.22
|
| Rate for Payer: Cigna of CA PPO |
$1,702.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,702.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.70
|
| Rate for Payer: EPIC Health Plan Senior |
$972.70
|
| Rate for Payer: Galaxy Health WC |
$2,066.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,544.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,434.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.62
|
| Rate for Payer: Multiplan Commercial |
$1,945.40
|
| Rate for Payer: Networks By Design Commercial |
$1,215.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,066.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$912.64
|
| Rate for Payer: United Healthcare All Other HMO |
$888.32
|
| Rate for Payer: United Healthcare HMO Rider |
$869.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$796.40
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206411030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.70
|
| Rate for Payer: Blue Shield of California Commercial |
$868.75
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$1,370.82
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206411030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,099.57
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,199.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,370.82
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,028.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.76
|
| Rate for Payer: United Healthcare All Other HMO |
$856.76
|
| Rate for Payer: United Healthcare HMO Rider |
$856.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206412030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,099.57
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,199.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,370.82
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,028.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.76
|
| Rate for Payer: United Healthcare All Other HMO |
$856.76
|
| Rate for Payer: United Healthcare HMO Rider |
$856.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206412030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.70
|
| Rate for Payer: Blue Shield of California Commercial |
$868.75
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$1,370.82
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206413030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,099.57
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,199.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,370.82
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,028.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.76
|
| Rate for Payer: United Healthcare All Other HMO |
$856.76
|
| Rate for Payer: United Healthcare HMO Rider |
$856.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
