|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
IP
|
$3.20
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Media |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: BCBS Transplant Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
OP
|
$10.56
|
|
|
Service Code
|
NDC 17478-215-15
|
| Hospital Charge Code |
NDG736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.29
|
| Rate for Payer: BCBS Transplant Transplant |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Media |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
OP
|
$13.03
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
1740156
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.76
|
| Rate for Payer: BCBS Transplant Transplant |
$7.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.61
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Media |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.42
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
IP
|
$10.56
|
|
|
Service Code
|
NDC 17478-215-15
|
| Hospital Charge Code |
NDG736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
IP
|
$13.03
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
1740156
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Blue Shield of California Commercial |
$9.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.67
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.42
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
IP
|
$21.54
|
|
|
Service Code
|
NDC 60219-1748-2
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$18.31 |
| Rate for Payer: Blue Shield of California Commercial |
$15.34
|
| Rate for Payer: Blue Shield of California EPN |
$11.03
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Networks By Design Commercial |
$14.00
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
OP
|
$21.54
|
|
|
Service Code
|
NDC 60219-1748-2
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$18.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.83
|
| Rate for Payer: BCBS Transplant Transplant |
$12.92
|
| Rate for Payer: Blue Shield of California Commercial |
$15.87
|
| Rate for Payer: Blue Shield of California EPN |
$12.58
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cigna of CA HMO |
$13.79
|
| Rate for Payer: Cigna of CA PPO |
$15.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.31
|
| Rate for Payer: Dignity Health Media |
$18.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.62
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Networks By Design Commercial |
$14.00
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Other HMO |
$10.77
|
| Rate for Payer: United Healthcare HMO Rider |
$10.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.31
|
| Rate for Payer: Vantage Medical Group Senior |
$18.31
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
NDC 0065-0817-02
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.51
|
| Rate for Payer: BCBS Transplant Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$15.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.26
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: Dignity Health Media |
$17.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.85
|
| Rate for Payer: Vantage Medical Group Senior |
$17.85
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
NDC 0065-0817-02
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Blue Shield of California Commercial |
$14.95
|
| Rate for Payer: Blue Shield of California EPN |
$10.75
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
ATROPINE 1 % EYE OINTMENT [735]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 24208-825-55
|
| Hospital Charge Code |
1740063
|
|
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
|
|
|
ATROPINE 1 % EYE OINTMENT [735]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 24208-825-55
|
| Hospital Charge Code |
1740063
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.60
|
| 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
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION [734]
|
Facility
OP
|
$15.07
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$12.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: BCBS Transplant Transplant |
$9.04
|
| Rate for Payer: Blue Shield of California Commercial |
$11.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Cigna of CA PPO |
$10.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.81
|
| Rate for Payer: Dignity Health Media |
$12.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$12.81
|
| Rate for Payer: Global Benefits Group Commercial |
$9.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Networks By Design Commercial |
$7.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.54
|
| Rate for Payer: United Healthcare HMO Rider |
$7.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.81
|
| Rate for Payer: Vantage Medical Group Senior |
$12.81
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION [734]
|
Facility
IP
|
$15.07
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$12.81 |
| Rate for Payer: Blue Shield of California Commercial |
$10.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.72
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Cigna of CA PPO |
$10.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$12.81
|
| Rate for Payer: Global Benefits Group Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Networks By Design Commercial |
$7.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.81
|
|
|
ATROPINE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080421]
|
Facility
IP
|
$2.10
|
|
|
Service Code
|
NDC 9994-0804-21
|
| Hospital Charge Code |
1721189
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.36
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
|
|
ATROPINE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080421]
|
Facility
OP
|
$2.10
|
|
|
Service Code
|
NDC 9994-0804-21
|
| Hospital Charge Code |
1721189
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: BCBS Transplant Transplant |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.78
|
| Rate for Payer: Dignity Health Media |
$1.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.36
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
|
|
Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report
|
Facility
OP
|
$799.16
|
|
|
Service Code
|
CPT 92652
|
| Min. Negotiated Rate |
$198.82 |
| Max. Negotiated Rate |
$799.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$799.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$75,540.52
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$39,758.17 |
| Max. Negotiated Rate |
$75,540.52 |
| Rate for Payer: IEHP Medi-Cal |
$57,947.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$39,758.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75,540.52
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$47,493.26
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$24,996.45 |
| Max. Negotiated Rate |
$47,493.26 |
| Rate for Payer: IEHP Medi-Cal |
$36,432.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$24,996.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,493.26
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$63,202.57
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$33,264.51 |
| Max. Negotiated Rate |
$63,202.57 |
| Rate for Payer: IEHP Medi-Cal |
$48,483.02
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$33,264.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,202.57
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$119,965.70
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$63,139.84 |
| Max. Negotiated Rate |
$119,965.70 |
| Rate for Payer: IEHP Medi-Cal |
$92,026.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$63,139.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119,965.70
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
OP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-110-30
|
| Hospital Charge Code |
ERX226931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$338.04 |
| Max. Negotiated Rate |
$1,197.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$923.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,197.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$774.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$774.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.20
|
| Rate for Payer: BCBS Transplant Transplant |
$845.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,038.08
|
| Rate for Payer: Blue Shield of California EPN |
$822.58
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,197.24
|
| Rate for Payer: Dignity Health Media |
$1,197.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,197.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,056.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.04
|
| Rate for Payer: Multiplan Commercial |
$1,126.82
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.26
|
| Rate for Payer: United Healthcare All Other HMO |
$704.26
|
| Rate for Payer: United Healthcare HMO Rider |
$704.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,197.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,197.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,197.24
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
IP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-110-30
|
| Hospital Charge Code |
ERX226931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$338.04 |
| Max. Negotiated Rate |
$1,197.24 |
| Rate for Payer: Blue Shield of California Commercial |
$1,002.87
|
| Rate for Payer: Blue Shield of California EPN |
$721.16
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.04
|
| Rate for Payer: Multiplan Commercial |
$1,126.82
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
|
