|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-02
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$314.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$263.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.70
|
| Rate for Payer: Blue Distinction Transplant |
$287.71
|
| Rate for Payer: Blue Shield of California Commercial |
$353.41
|
| Rate for Payer: Blue Shield of California EPN |
$280.04
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.59
|
| Rate for Payer: Dignity Health Media |
$407.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.08
|
| Rate for Payer: Multiplan Commercial |
$383.62
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.76
|
| Rate for Payer: United Healthcare All Other HMO |
$239.76
|
| Rate for Payer: United Healthcare HMO Rider |
$239.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.59
|
| Rate for Payer: Vantage Medical Group Senior |
$407.59
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$314.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$263.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.70
|
| Rate for Payer: Blue Distinction Transplant |
$287.71
|
| Rate for Payer: Blue Shield of California Commercial |
$353.41
|
| Rate for Payer: Blue Shield of California EPN |
$280.04
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.59
|
| Rate for Payer: Dignity Health Media |
$407.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.08
|
| Rate for Payer: Multiplan Commercial |
$383.62
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.76
|
| Rate for Payer: United Healthcare All Other HMO |
$239.76
|
| Rate for Payer: United Healthcare HMO Rider |
$239.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.59
|
| Rate for Payer: Vantage Medical Group Senior |
$407.59
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Blue Shield of California Commercial |
$341.42
|
| Rate for Payer: Blue Shield of California EPN |
$245.51
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.08
|
| Rate for Payer: Multiplan Commercial |
$383.62
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.07
|
| Rate for Payer: United Healthcare All Other HMO |
$176.85
|
| Rate for Payer: United Healthcare HMO Rider |
$173.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.24
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-02
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Blue Shield of California Commercial |
$341.42
|
| Rate for Payer: Blue Shield of California EPN |
$245.51
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.08
|
| Rate for Payer: Multiplan Commercial |
$383.62
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.07
|
| Rate for Payer: United Healthcare All Other HMO |
$176.85
|
| Rate for Payer: United Healthcare HMO Rider |
$173.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.24
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$17,686.72
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$13,567.58 |
| Max. Negotiated Rate |
$17,686.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,567.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,686.72
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$31,493.11
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$24,158.53 |
| Max. Negotiated Rate |
$31,493.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24,158.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,493.11
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$13,144.88
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$10,083.51 |
| Max. Negotiated Rate |
$13,144.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,083.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,144.88
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$10,357.01
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$7,944.92 |
| Max. Negotiated Rate |
$10,357.01 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,944.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,357.01
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Distinction Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Media |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Distinction Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Media |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Blue Shield of California Commercial |
$5.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.26
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Blue Shield of California Commercial |
$5.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.26
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
|
IP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Blue Shield of California Commercial |
$10.77
|
| Rate for Payer: Blue Shield of California EPN |
$7.75
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$12.10
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
|
OP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.01
|
| Rate for Payer: Blue Distinction Transplant |
$9.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.15
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: Dignity Health Media |
$12.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$12.10
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.56
|
| Rate for Payer: United Healthcare All Other HMO |
$7.56
|
| Rate for Payer: United Healthcare HMO Rider |
$7.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.86
|
| Rate for Payer: Vantage Medical Group Senior |
$12.86
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
IP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$506.24 |
| Max. Negotiated Rate |
$1,792.95 |
| Rate for Payer: Blue Shield of California Commercial |
$1,501.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,079.99
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$843.74
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$803.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.24
|
| Rate for Payer: Multiplan Commercial |
$1,687.48
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.49
|
| Rate for Payer: United Healthcare All Other HMO |
$777.93
|
| Rate for Payer: United Healthcare HMO Rider |
$761.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.09
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
OP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,792.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,265.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,554.59
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Media |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,582.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$40.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,687.48
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,265.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,265.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,054.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,054.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,054.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
|
IP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.87 |
| Max. Negotiated Rate |
$1,657.03 |
| Rate for Payer: Blue Shield of California Commercial |
$1,388.01
|
| Rate for Payer: Blue Shield of California EPN |
$998.12
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$779.78
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.87
|
| Rate for Payer: Multiplan Commercial |
$1,559.56
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.11
|
| Rate for Payer: United Healthcare All Other HMO |
$718.96
|
| Rate for Payer: United Healthcare HMO Rider |
$703.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.32
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
|
OP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,657.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,169.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.74
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Media |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,462.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$40.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,559.56
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,169.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$974.72
|
| Rate for Payer: United Healthcare All Other HMO |
$974.72
|
| Rate for Payer: United Healthcare HMO Rider |
$974.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$974.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$6,114.88
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$4,690.76 |
| Max. Negotiated Rate |
$6,114.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,690.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,114.88
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$13,556.33
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$10,399.13 |
| Max. Negotiated Rate |
$13,556.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,399.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,556.33
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$8,439.90
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$6,474.29 |
| Max. Negotiated Rate |
$8,439.90 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,474.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,439.90
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$23,725.36
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$18,199.85 |
| Max. Negotiated Rate |
$23,725.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,199.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,725.36
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$6,792.35
|
|
|
Service Code
|
APR-DRG 7542
|
| Min. Negotiated Rate |
$5,210.45 |
| Max. Negotiated Rate |
$6,792.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,210.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,792.35
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$22,792.51
|
|
|
Service Code
|
APR-DRG 7544
|
| Min. Negotiated Rate |
$17,484.26 |
| Max. Negotiated Rate |
$22,792.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,484.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,792.51
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$10,777.31
|
|
|
Service Code
|
APR-DRG 7543
|
| Min. Negotiated Rate |
$8,267.33 |
| Max. Negotiated Rate |
$10,777.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,267.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,777.31
|
|
