|
DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14845]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
1771187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
|
|
DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14845]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
1771187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| 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 |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| 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 |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
DOPAMINE 40 MG/50 ML D5.2NS SYRINGE [4080662]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
NDC4080662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| 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 |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| 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 |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
DOPAMINE 40 MG/50 ML D5.2NS SYRINGE [4080662]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
NDC4080662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
|
|
DOPAMINE 800 MG/250 ML (3,200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14846]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
1771255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
DOPAMINE 800 MG/250 ML (3,200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14846]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
1771255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| 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 |
$0.03
|
|
|
DOPAMINE 80 MG/50 ML D5.2NS SYRINGE [4080663]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
NDC4080663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
DOPAMINE 80 MG/50 ML D5.2NS SYRINGE [4080663]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
CPT J1265
|
| Hospital Charge Code |
NDC4080663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| 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 |
$0.03
|
|
|
DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION [12211]
|
Facility
|
IP
|
$60.53
|
|
|
Service Code
|
NDC 50242-100-40
|
| Hospital Charge Code |
1744070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Blue Shield of California Commercial |
$43.10
|
| Rate for Payer: Blue Shield of California EPN |
$30.99
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cigna of CA HMO |
$42.37
|
| Rate for Payer: Cigna of CA PPO |
$42.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: Galaxy Health WC |
$51.45
|
| Rate for Payer: Global Benefits Group Commercial |
$36.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.42
|
| Rate for Payer: Networks By Design Commercial |
$39.34
|
| Rate for Payer: Prime Health Services Commercial |
$51.45
|
|
|
DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION [12211]
|
Facility
|
IP
|
$60.53
|
|
|
Service Code
|
NDC 50242-100-39
|
| Hospital Charge Code |
1744070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Blue Shield of California Commercial |
$43.10
|
| Rate for Payer: Blue Shield of California EPN |
$30.99
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cigna of CA HMO |
$42.37
|
| Rate for Payer: Cigna of CA PPO |
$42.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: Galaxy Health WC |
$51.45
|
| Rate for Payer: Global Benefits Group Commercial |
$36.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.42
|
| Rate for Payer: Networks By Design Commercial |
$39.34
|
| Rate for Payer: Prime Health Services Commercial |
$51.45
|
|
|
DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION [12211]
|
Facility
|
OP
|
$60.53
|
|
|
Service Code
|
NDC 50242-100-40
|
| Hospital Charge Code |
1744070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.06
|
| Rate for Payer: Blue Distinction Transplant |
$36.32
|
| Rate for Payer: Blue Shield of California Commercial |
$44.61
|
| Rate for Payer: Blue Shield of California EPN |
$35.35
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cigna of CA HMO |
$42.37
|
| Rate for Payer: Cigna of CA PPO |
$42.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.45
|
| Rate for Payer: Dignity Health Media |
$51.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.21
|
| Rate for Payer: Galaxy Health WC |
$51.45
|
| Rate for Payer: Global Benefits Group Commercial |
$36.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.42
|
| Rate for Payer: Networks By Design Commercial |
$39.34
|
| Rate for Payer: Prime Health Services Commercial |
$51.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.26
|
| Rate for Payer: United Healthcare All Other HMO |
$30.26
|
| Rate for Payer: United Healthcare HMO Rider |
$30.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.45
|
| Rate for Payer: Vantage Medical Group Senior |
$51.45
|
|
|
DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION [12211]
|
Facility
|
OP
|
$60.53
|
|
|
Service Code
|
NDC 50242-100-39
|
| Hospital Charge Code |
1744070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.06
|
| Rate for Payer: Blue Distinction Transplant |
$36.32
|
| Rate for Payer: Blue Shield of California Commercial |
$44.61
|
| Rate for Payer: Blue Shield of California EPN |
$35.35
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cigna of CA HMO |
$42.37
|
| Rate for Payer: Cigna of CA PPO |
$42.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.45
|
| Rate for Payer: Dignity Health Media |
$51.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.21
|
| Rate for Payer: Galaxy Health WC |
$51.45
|
| Rate for Payer: Global Benefits Group Commercial |
$36.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.42
|
| Rate for Payer: Networks By Design Commercial |
$39.34
|
| Rate for Payer: Prime Health Services Commercial |
$51.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.26
|
| Rate for Payer: United Healthcare All Other HMO |
$30.26
|
| Rate for Payer: United Healthcare HMO Rider |
$30.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.45
|
| Rate for Payer: Vantage Medical Group Senior |
$51.45
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$44,242.51
|
|
|
Service Code
|
APR-DRG 3041
|
| Min. Negotiated Rate |
$33,938.66 |
| Max. Negotiated Rate |
$44,242.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,938.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44,242.51
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$52,558.26
|
|
|
Service Code
|
APR-DRG 3042
|
| Min. Negotiated Rate |
$40,317.71 |
| Max. Negotiated Rate |
$52,558.26 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,317.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,558.26
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$74,132.40
|
|
|
Service Code
|
APR-DRG 3043
|
| Min. Negotiated Rate |
$56,867.35 |
| Max. Negotiated Rate |
$74,132.40 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56,867.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74,132.40
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$109,697.37
|
|
|
Service Code
|
APR-DRG 3044
|
| Min. Negotiated Rate |
$84,149.43 |
| Max. Negotiated Rate |
$109,697.37 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84,149.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109,697.37
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$142,919.60
|
|
|
Service Code
|
APR-DRG 3034
|
| Min. Negotiated Rate |
$109,634.37 |
| Max. Negotiated Rate |
$142,919.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109,634.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142,919.60
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$78,621.03
|
|
|
Service Code
|
APR-DRG 3032
|
| Min. Negotiated Rate |
$60,310.61 |
| Max. Negotiated Rate |
$78,621.03 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60,310.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78,621.03
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$108,212.98
|
|
|
Service Code
|
APR-DRG 3033
|
| Min. Negotiated Rate |
$83,010.75 |
| Max. Negotiated Rate |
$108,212.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83,010.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108,212.98
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$65,458.40
|
|
|
Service Code
|
APR-DRG 3031
|
| Min. Negotiated Rate |
$50,213.48 |
| Max. Negotiated Rate |
$65,458.40 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50,213.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65,458.40
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 42571-147-26
|
| Hospital Charge Code |
1740314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 61314-030-02
|
| Hospital Charge Code |
1740314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50383-233-10
|
| Hospital Charge Code |
1740314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 42571-147-26
|
| Hospital Charge Code |
1740314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 24208-486-10
|
| Hospital Charge Code |
1740314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
