|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 6068768111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 5026834611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 8770140733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5026834611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5026834615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 5026834615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 8770140733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$6.12
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$6.12
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.50
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$7.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.43
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$6.12
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$6.12
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$6.99
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 9994080276
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 9994080276
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$669.80 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$15.16
|
| Rate for Payer: Blue Shield of California Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA HMO |
$840.00
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: Networks By Design Commercial |
$600.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.36
|
| Rate for Payer: United Healthcare All Other HMO |
$438.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$428.88
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$669.80 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$922.80
|
| Rate for Payer: Blue Shield of California Commercial |
$399.52
|
| Rate for Payer: Blue Shield of California Commercial |
$605.97
|
| Rate for Payer: Blue Shield of California Commercial |
$608.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA HMO |
$840.00
|
| Rate for Payer: Cigna of CA PPO |
$840.00
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$315.20
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.12
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: Networks By Design Commercial |
$600.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare All Other HMO |
$438.36
|
| Rate for Payer: United Healthcare HMO Rider |
$428.88
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
OP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$74.08 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.01
|
| Rate for Payer: Multiplan Commercial |
$69.72
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.08
|
| Rate for Payer: Vantage Medical Group Senior |
$74.08
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
IP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$74.08 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California Commercial |
$44.19
|
| Rate for Payer: Blue Shield of California Commercial |
$67.02
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.92
|
| Rate for Payer: Multiplan Commercial |
$69.72
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
OP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$47.73
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.71
|
| Rate for Payer: Vantage Medical Group Senior |
$50.71
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
IP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Blue Shield of California Commercial |
$30.25
|
| Rate for Payer: Blue Shield of California Commercial |
$45.88
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.32
|
| Rate for Payer: Multiplan Commercial |
$47.73
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$94.01 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Multiplan Commercial |
$86.91
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
| Rate for Payer: Vantage Medical Group Senior |
$94.01
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$94.01 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Blue Shield of California Commercial |
$83.54
|
| Rate for Payer: Blue Shield of California Commercial |
$56.07
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California Commercial |
$55.08
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Multiplan Commercial |
$86.91
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$39,302.70
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$31,390.44 |
| Max. Negotiated Rate |
$39,302.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31,390.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39,302.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,165.57
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$20,768.92
|
|
|
Service Code
|
APR-DRG 3141
|
| Min. Negotiated Rate |
$16,587.81 |
| Max. Negotiated Rate |
$20,768.92 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,587.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,768.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,582.72
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$27,183.41
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$21,710.96 |
| Max. Negotiated Rate |
$27,183.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,710.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,183.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,322.00
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$85,649.91
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$68,407.23 |
| Max. Negotiated Rate |
$85,649.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68,407.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85,649.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76,634.13
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$112,418.25
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$112,418.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,666.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$112,418.25
|
| Rate for Payer: EPIC Health Plan Senior |
$74,945.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,132.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95,385.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,297.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$128,777.20
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$128,777.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84,614.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$128,777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$85,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78,046.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109,265.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104,582.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
