|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 3290975001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 3290975003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 3290975001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 3290975003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
BARRIER FILM CAVILON SPRAY
|
Facility
|
OP
|
$58.96
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$50.12 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.83
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Cigna of CA HMO |
$37.73
|
| Rate for Payer: Cigna of CA PPO |
$43.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.27
|
| Rate for Payer: Multiplan Commercial |
$47.17
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.48
|
| Rate for Payer: United Healthcare All Other HMO |
$29.48
|
| Rate for Payer: United Healthcare HMO Rider |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.12
|
|
|
BARRIER FILM CAVILON SPRAY
|
Facility
|
IP
|
$58.96
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$50.12 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$47.17
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION [23082]
|
Facility
|
IP
|
$5,692.03
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,138.41 |
| Max. Negotiated Rate |
$4,838.23 |
| Rate for Payer: Adventist Health Commercial |
$1,138.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,885.86
|
| Rate for Payer: Blue Shield of California Commercial |
$4,377.17
|
| Rate for Payer: Cash Price |
$2,561.41
|
| Rate for Payer: Cigna of CA HMO |
$3,984.42
|
| Rate for Payer: Cigna of CA PPO |
$3,984.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,984.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,276.81
|
| Rate for Payer: EPIC Health Plan Senior |
$2,276.81
|
| Rate for Payer: Galaxy Health WC |
$4,838.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,614.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,358.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.09
|
| Rate for Payer: Multiplan Commercial |
$4,553.62
|
| Rate for Payer: Networks By Design Commercial |
$2,846.01
|
| Rate for Payer: Prime Health Services Commercial |
$4,838.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,136.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,079.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2,034.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,864.14
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION [23082]
|
Facility
|
OP
|
$5,692.03
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,138.41 |
| Max. Negotiated Rate |
$29,482.87 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,395.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5,395.56
|
| Rate for Payer: Adventist Health Commercial |
$1,138.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29,482.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,131.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,395.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,395.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,591.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,363.72
|
| Rate for Payer: Cash Price |
$2,561.41
|
| Rate for Payer: Cash Price |
$2,561.41
|
| Rate for Payer: Cigna of CA HMO |
$3,984.42
|
| Rate for Payer: Cigna of CA PPO |
$3,984.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,131.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,395.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,395.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,984.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,093.33
|
| Rate for Payer: EPIC Health Plan Senior |
$5,395.56
|
| Rate for Payer: Galaxy Health WC |
$4,838.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,044.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,905.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,905.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,614.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,084.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,867.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,180.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,572.77
|
| Rate for Payer: Multiplan Commercial |
$4,553.62
|
| Rate for Payer: Networks By Design Commercial |
$2,846.01
|
| Rate for Payer: Prime Health Services Commercial |
$4,838.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,415.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,415.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,136.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,079.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2,034.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,864.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,905.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,131.31
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION [117851]
|
Facility
|
IP
|
$227.10
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.42 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Adventist Health Commercial |
$45.42
|
| Rate for Payer: Blue Shield of California Commercial |
$115.14
|
| Rate for Payer: Blue Shield of California Commercial |
$174.64
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: Cigna of CA HMO |
$158.97
|
| Rate for Payer: Cigna of CA PPO |
$158.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.84
|
| Rate for Payer: EPIC Health Plan Senior |
$90.84
|
| Rate for Payer: Galaxy Health WC |
$193.03
|
| Rate for Payer: Global Benefits Group Commercial |
$136.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$181.68
|
| Rate for Payer: Networks By Design Commercial |
$113.55
|
| Rate for Payer: Prime Health Services Commercial |
$193.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.23
|
| Rate for Payer: United Healthcare All Other HMO |
$82.96
|
| Rate for Payer: United Healthcare HMO Rider |
$81.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.38
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION [117851]
|
Facility
|
OP
|
$227.10
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Adventist Health Commercial |
$45.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: Cigna of CA HMO |
$158.97
|
| Rate for Payer: Cigna of CA PPO |
$158.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Senior |
$3.72
|
| Rate for Payer: Galaxy Health WC |
$193.03
|
| Rate for Payer: Global Benefits Group Commercial |
$136.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$181.68
|
| Rate for Payer: Networks By Design Commercial |
$113.55
|
| Rate for Payer: Prime Health Services Commercial |
$193.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.23
|
| Rate for Payer: United Healthcare All Other HMO |
$82.96
|
| Rate for Payer: United Healthcare HMO Rider |
$81.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: Vantage Medical Group Senior |
$3.38
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 9999999807
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 9999999807
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994080247
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994080247
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BEER [4080757]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 9994080757
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BEER [4080757]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 9994080757
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$116,075.45
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$116,075.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,914.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$116,075.45
|
| Rate for Payer: EPIC Health Plan Senior |
$77,383.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70,348.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98,488.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94,267.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]
|
Facility
|
OP
|
$1,163.86
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$989.28 |
| Rate for Payer: Adventist Health Commercial |
$232.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cigna of CA HMO |
$814.70
|
| Rate for Payer: Cigna of CA PPO |
$814.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$814.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Senior |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$989.28
|
| Rate for Payer: Global Benefits Group Commercial |
$698.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$931.09
|
| Rate for Payer: Networks By Design Commercial |
$581.93
|
| Rate for Payer: Prime Health Services Commercial |
$989.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$698.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Other HMO |
$425.16
|
| Rate for Payer: United Healthcare HMO Rider |
$415.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$381.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]
|
Facility
|
IP
|
$1,163.86
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.77 |
| Max. Negotiated Rate |
$989.28 |
| Rate for Payer: Adventist Health Commercial |
$232.77
|
| Rate for Payer: Blue Shield of California Commercial |
$590.08
|
| Rate for Payer: Blue Shield of California Commercial |
$895.01
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cigna of CA HMO |
$814.70
|
| Rate for Payer: Cigna of CA PPO |
$814.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$814.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.54
|
| Rate for Payer: EPIC Health Plan Senior |
$465.54
|
| Rate for Payer: Galaxy Health WC |
$989.28
|
| Rate for Payer: Global Benefits Group Commercial |
$698.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$686.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.33
|
| Rate for Payer: Multiplan Commercial |
$931.09
|
| Rate for Payer: Networks By Design Commercial |
$581.93
|
| Rate for Payer: Prime Health Services Commercial |
$989.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Other HMO |
$425.16
|
| Rate for Payer: United Healthcare HMO Rider |
$415.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$381.16
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
|
IP
|
$808.33
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.67 |
| Max. Negotiated Rate |
$687.08 |
| Rate for Payer: Adventist Health Commercial |
$161.67
|
| Rate for Payer: Blue Shield of California Commercial |
$409.82
|
| Rate for Payer: Blue Shield of California Commercial |
$621.61
|
| Rate for Payer: Cash Price |
$363.75
|
| Rate for Payer: Cigna of CA HMO |
$565.83
|
| Rate for Payer: Cigna of CA PPO |
$565.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$565.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.33
|
| Rate for Payer: EPIC Health Plan Senior |
$323.33
|
| Rate for Payer: Galaxy Health WC |
$687.08
|
| Rate for Payer: Global Benefits Group Commercial |
$485.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$476.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$646.66
|
| Rate for Payer: Networks By Design Commercial |
$404.17
|
| Rate for Payer: Prime Health Services Commercial |
$687.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.37
|
| Rate for Payer: United Healthcare All Other HMO |
$295.28
|
| Rate for Payer: United Healthcare HMO Rider |
$288.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.73
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
|
OP
|
$808.33
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$687.08 |
| Rate for Payer: Cigna of CA PPO |
$565.83
|
| Rate for Payer: Adventist Health Commercial |
$161.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.39
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Cash Price |
$363.75
|
| Rate for Payer: Cash Price |
$363.75
|
| Rate for Payer: Cigna of CA HMO |
$565.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$565.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.19
|
| Rate for Payer: EPIC Health Plan Senior |
$64.13
|
| Rate for Payer: Galaxy Health WC |
$687.08
|
| Rate for Payer: Global Benefits Group Commercial |
$485.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.12
|
| Rate for Payer: Multiplan Commercial |
$646.66
|
| Rate for Payer: Networks By Design Commercial |
$404.17
|
| Rate for Payer: Prime Health Services Commercial |
$687.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.37
|
| Rate for Payer: United Healthcare All Other HMO |
$295.28
|
| Rate for Payer: United Healthcare HMO Rider |
$288.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.13
|
| Rate for Payer: Vantage Medical Group Senior |
$64.13
|
|
