|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$13.62
|
| Rate for Payer: Blue Shield of California Commercial |
$8.98
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.56
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7.88
|
| Rate for Payer: Blue Shield of California Commercial |
$13.62
|
| Rate for Payer: Blue Shield of California Commercial |
$8.98
|
| Rate for Payer: Blue Shield of California Commercial |
$11.95
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.43
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
OP
|
$15.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.56
|
| Rate for Payer: Blue Shield of California Commercial |
$13.56
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.22
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Multiplan Commercial |
$12.43
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.21
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$182,850.68
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$146,039.95 |
| Max. Negotiated Rate |
$182,850.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146,039.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182,850.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163,603.24
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$85,601.76
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$68,368.78 |
| Max. Negotiated Rate |
$85,601.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68,368.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85,601.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76,591.05
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$104,132.82
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$83,169.24 |
| Max. Negotiated Rate |
$104,132.82 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83,169.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104,132.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93,171.48
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$72,095.71
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$57,581.70 |
| Max. Negotiated Rate |
$72,095.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57,581.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72,095.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,506.69
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Adventist Health Commercial |
$119.04
|
| Rate for Payer: Blue Shield of California Commercial |
$301.77
|
| Rate for Payer: Blue Shield of California Commercial |
$457.71
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$416.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.08
|
| Rate for Payer: EPIC Health Plan Senior |
$238.08
|
| Rate for Payer: Galaxy Health WC |
$505.92
|
| Rate for Payer: Global Benefits Group Commercial |
$357.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.85
|
| Rate for Payer: Multiplan Commercial |
$476.16
|
| Rate for Payer: Networks By Design Commercial |
$297.60
|
| Rate for Payer: Prime Health Services Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.38
|
| Rate for Payer: United Healthcare All Other HMO |
$217.43
|
| Rate for Payer: United Healthcare HMO Rider |
$212.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.93
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$595.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Adventist Health Commercial |
$119.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.40
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$416.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.08
|
| Rate for Payer: EPIC Health Plan Senior |
$238.08
|
| Rate for Payer: Galaxy Health WC |
$505.92
|
| Rate for Payer: Global Benefits Group Commercial |
$357.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.64
|
| Rate for Payer: Multiplan Commercial |
$476.16
|
| Rate for Payer: Networks By Design Commercial |
$297.60
|
| Rate for Payer: Prime Health Services Commercial |
$505.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.38
|
| Rate for Payer: United Healthcare All Other HMO |
$217.43
|
| Rate for Payer: United Healthcare HMO Rider |
$212.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.92
|
| Rate for Payer: Vantage Medical Group Senior |
$505.92
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]
|
Facility
|
IP
|
$586.14
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.23 |
| Max. Negotiated Rate |
$498.22 |
| Rate for Payer: Adventist Health Commercial |
$117.23
|
| Rate for Payer: Blue Shield of California Commercial |
$297.17
|
| Rate for Payer: Blue Shield of California Commercial |
$450.74
|
| Rate for Payer: Cash Price |
$263.76
|
| Rate for Payer: Cigna of CA HMO |
$410.30
|
| Rate for Payer: Cigna of CA PPO |
$410.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.46
|
| Rate for Payer: EPIC Health Plan Senior |
$234.46
|
| Rate for Payer: Galaxy Health WC |
$498.22
|
| Rate for Payer: Global Benefits Group Commercial |
$351.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.67
|
| Rate for Payer: Multiplan Commercial |
$468.91
|
| Rate for Payer: Networks By Design Commercial |
$293.07
|
| Rate for Payer: Prime Health Services Commercial |
$498.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.98
|
| Rate for Payer: United Healthcare All Other HMO |
$214.12
|
| Rate for Payer: United Healthcare HMO Rider |
$209.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.96
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]
|
Facility
|
OP
|
$586.14
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$498.22 |
| Rate for Payer: Adventist Health Commercial |
$117.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$263.76
|
| Rate for Payer: Cash Price |
$263.76
|
| Rate for Payer: Cigna of CA HMO |
$410.30
|
| Rate for Payer: Cigna of CA PPO |
$410.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$498.22
|
| Rate for Payer: Global Benefits Group Commercial |
$351.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$468.91
|
| Rate for Payer: Networks By Design Commercial |
$293.07
|
| Rate for Payer: Prime Health Services Commercial |
$498.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.98
|
| Rate for Payer: United Healthcare All Other HMO |
$214.12
|
| Rate for Payer: United Healthcare HMO Rider |
$209.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.93
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$25,671.56
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$20,503.47 |
| Max. Negotiated Rate |
$25,671.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,503.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,671.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,969.29
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$61,247.49
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$48,917.40 |
| Max. Negotiated Rate |
$61,247.49 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48,917.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61,247.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,800.38
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$15,151.13
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$12,100.97 |
| Max. Negotiated Rate |
$15,151.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,100.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,151.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,556.28
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$19,034.10
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$15,202.24 |
| Max. Negotiated Rate |
$19,034.10 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,202.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,034.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,030.51
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$120,472.60
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$120,472.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70,427.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$120,472.60
|
| Rate for Payer: EPIC Health Plan Senior |
$80,315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73,013.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102,219.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,838.36
|
| 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
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$102,239.81
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$102,239.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,277.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,239.81
|
| Rate for Payer: EPIC Health Plan Senior |
$68,159.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,963.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,748.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,031.12
|
| 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
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
IP
|
$2,508.16
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$501.63 |
| Max. Negotiated Rate |
$2,131.94 |
| Rate for Payer: Adventist Health Commercial |
$501.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,271.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,928.78
|
| Rate for Payer: Cash Price |
$1,128.67
|
| Rate for Payer: Cigna of CA HMO |
$1,755.71
|
| Rate for Payer: Cigna of CA PPO |
$1,755.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,755.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,003.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.26
|
| Rate for Payer: Galaxy Health WC |
$2,131.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,592.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,479.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.96
|
| Rate for Payer: Multiplan Commercial |
$2,006.53
|
| Rate for Payer: Networks By Design Commercial |
$1,254.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,131.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$941.31
|
| Rate for Payer: United Healthcare All Other HMO |
$916.23
|
| Rate for Payer: United Healthcare HMO Rider |
$896.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$821.42
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
OP
|
$2,508.16
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$2,131.94 |
| Rate for Payer: Adventist Health Commercial |
$501.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.76
|
| Rate for Payer: Cash Price |
$1,128.67
|
| Rate for Payer: Cash Price |
$1,128.67
|
| Rate for Payer: Cigna of CA HMO |
$1,755.71
|
| Rate for Payer: Cigna of CA PPO |
$1,755.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,755.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.66
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
| Rate for Payer: Galaxy Health WC |
$2,131.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$49.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,592.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.33
|
| Rate for Payer: Multiplan Commercial |
$2,006.53
|
| Rate for Payer: Networks By Design Commercial |
$1,254.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,131.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$941.31
|
| Rate for Payer: United Healthcare All Other HMO |
$916.23
|
| Rate for Payer: United Healthcare HMO Rider |
$896.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$821.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Vantage Medical Group Senior |
$33.11
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
|
IP
|
$2,318.03
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$463.61 |
| Max. Negotiated Rate |
$1,970.33 |
| Rate for Payer: Adventist Health Commercial |
$463.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,782.57
|
| Rate for Payer: Cash Price |
$1,043.11
|
| Rate for Payer: Cigna of CA HMO |
$1,622.62
|
| Rate for Payer: Cigna of CA PPO |
$1,622.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,622.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$927.21
|
| Rate for Payer: EPIC Health Plan Senior |
$927.21
|
| Rate for Payer: Galaxy Health WC |
$1,970.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,390.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,471.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.33
|
| Rate for Payer: Multiplan Commercial |
$1,854.42
|
| Rate for Payer: Networks By Design Commercial |
$1,159.02
|
| Rate for Payer: Prime Health Services Commercial |
$1,970.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.96
|
| Rate for Payer: United Healthcare All Other HMO |
$846.78
|
| Rate for Payer: United Healthcare HMO Rider |
$828.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$759.15
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
|
OP
|
$2,318.03
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$1,970.33 |
| Rate for Payer: Adventist Health Commercial |
$463.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.76
|
| Rate for Payer: Cash Price |
$1,043.11
|
| Rate for Payer: Cash Price |
$1,043.11
|
| Rate for Payer: Cigna of CA HMO |
$1,622.62
|
| Rate for Payer: Cigna of CA PPO |
$1,622.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,622.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.66
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
| Rate for Payer: Galaxy Health WC |
$1,970.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,390.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$49.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,471.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.33
|
| Rate for Payer: Multiplan Commercial |
$1,854.42
|
| Rate for Payer: Networks By Design Commercial |
$1,159.02
|
| Rate for Payer: Prime Health Services Commercial |
$1,970.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,390.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.96
|
| Rate for Payer: United Healthcare All Other HMO |
$846.78
|
| Rate for Payer: United Healthcare HMO Rider |
$828.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$759.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Vantage Medical Group Senior |
$33.11
|
|
|
DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYRINGE [245944]
|
Facility
|
IP
|
$1,924.96
|
|
|
Service Code
|
HCPCS Q5136
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.99 |
| Max. Negotiated Rate |
$1,636.22 |
| Rate for Payer: Adventist Health Commercial |
$384.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.29
|
| Rate for Payer: Blue Shield of California Commercial |
$975.95
|
| Rate for Payer: Cash Price |
$866.23
|
| Rate for Payer: Cigna of CA HMO |
$1,347.47
|
| Rate for Payer: Cigna of CA PPO |
$1,347.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,347.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.98
|
| Rate for Payer: EPIC Health Plan Senior |
$769.98
|
| Rate for Payer: Galaxy Health WC |
$1,636.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,222.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,135.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.99
|
| Rate for Payer: Multiplan Commercial |
$1,539.97
|
| Rate for Payer: Networks By Design Commercial |
$962.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$722.44
|
| Rate for Payer: United Healthcare All Other HMO |
$703.19
|
| Rate for Payer: United Healthcare HMO Rider |
$687.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.42
|
|
|
DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYRINGE [245944]
|
Facility
|
OP
|
$1,924.96
|
|
|
Service Code
|
HCPCS Q5136
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$1,636.22 |
| Rate for Payer: Adventist Health Commercial |
$384.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,262.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.22
|
| Rate for Payer: Cash Price |
$866.23
|
| Rate for Payer: Cash Price |
$866.23
|
| Rate for Payer: Cigna of CA HMO |
$1,347.47
|
| Rate for Payer: Cigna of CA PPO |
$1,347.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,347.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.66
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$1,636.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,222.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.08
|
| Rate for Payer: Multiplan Commercial |
$1,539.97
|
| Rate for Payer: Networks By Design Commercial |
$962.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$722.44
|
| Rate for Payer: United Healthcare All Other HMO |
$703.19
|
| Rate for Payer: United Healthcare HMO Rider |
$687.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.44
|
| Rate for Payer: Vantage Medical Group Senior |
$27.67
|
|
|
DENOSUMAB-BMWO 60 MG/ML SUBCUTANEOUS SYRINGE [246286]
|
Facility
|
OP
|
$2,137.99
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$1,817.29 |
| Rate for Payer: Adventist Health Commercial |
$427.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,402.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.86
|
| Rate for Payer: Cash Price |
$962.10
|
| Rate for Payer: Cash Price |
$962.10
|
| Rate for Payer: Cigna of CA HMO |
$1,496.59
|
| Rate for Payer: Cigna of CA PPO |
$1,496.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,496.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.87
|
| Rate for Payer: EPIC Health Plan Senior |
$28.58
|
| Rate for Payer: Galaxy Health WC |
$1,817.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1,282.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,357.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.81
|
| Rate for Payer: Multiplan Commercial |
$1,710.39
|
| Rate for Payer: Networks By Design Commercial |
$1,068.99
|
| Rate for Payer: Prime Health Services Commercial |
$1,817.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,282.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,282.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$802.39
|
| Rate for Payer: United Healthcare All Other HMO |
$781.01
|
| Rate for Payer: United Healthcare HMO Rider |
$764.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.58
|
| Rate for Payer: Vantage Medical Group Senior |
$25.98
|
|
