|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Blue Shield of California Commercial |
$13.79
|
| Rate for Payer: Blue Shield of California EPN |
$9.92
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$277.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$277.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.28
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$14.28
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: Dignity Health Media |
$44.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$72.41
|
| Rate for Payer: IEHP Medi-Cal |
$71.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$71.53
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$277.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$277.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.28
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$14.28
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: Dignity Health Media |
$44.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$72.41
|
| Rate for Payer: IEHP Medi-Cal |
$71.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$71.53
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Blue Shield of California Commercial |
$13.79
|
| Rate for Payer: Blue Shield of California EPN |
$9.92
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
1759128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$277.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$277.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.28
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$14.28
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: Dignity Health Media |
$44.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$72.41
|
| Rate for Payer: IEHP Medi-Cal |
$71.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$71.53
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [210304]
|
Facility
IP
|
$2,587.56
|
|
|
Service Code
|
CPT J1566
|
| Hospital Charge Code |
NDG10258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$621.01 |
| Max. Negotiated Rate |
$2,199.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1,842.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,324.83
|
| Rate for Payer: Cash Price |
$1,164.40
|
| Rate for Payer: Cigna of CA HMO |
$1,811.29
|
| Rate for Payer: Cigna of CA PPO |
$1,811.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,035.02
|
| Rate for Payer: Galaxy Health WC |
$2,199.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,725.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$985.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.01
|
| Rate for Payer: Multiplan Commercial |
$2,070.05
|
| Rate for Payer: Networks By Design Commercial |
$1,293.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.43
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [210304]
|
Facility
OP
|
$2,587.56
|
|
|
Service Code
|
CPT J1566
|
| Hospital Charge Code |
NDG10258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$2,199.43 |
| Rate for Payer: IEHP Medicare Advantage |
$78.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$493.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$86.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.02
|
| Rate for Payer: BCBS Transplant Transplant |
$1,552.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,907.03
|
| Rate for Payer: Blue Shield of California EPN |
$112.75
|
| Rate for Payer: Cash Price |
$1,164.40
|
| Rate for Payer: Cash Price |
$1,164.40
|
| Rate for Payer: Cigna of CA HMO |
$1,811.29
|
| Rate for Payer: Cigna of CA PPO |
$1,811.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.75
|
| Rate for Payer: Dignity Health Media |
$78.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$78.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$78.50
|
| Rate for Payer: Galaxy Health WC |
$2,199.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,940.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$128.74
|
| Rate for Payer: IEHP Medi-Cal |
$127.17
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$127.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,725.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.19
|
| Rate for Payer: Multiplan Commercial |
$2,070.05
|
| Rate for Payer: Networks By Design Commercial |
$1,293.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,552.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,552.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,293.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,293.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,293.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,293.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Vantage Medical Group Senior |
$78.50
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
OP
|
$22.41
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG207352D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$282.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$282.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.87
|
| Rate for Payer: BCBS Transplant Transplant |
$13.45
|
| Rate for Payer: Blue Shield of California Commercial |
$16.52
|
| Rate for Payer: Blue Shield of California EPN |
$102.15
|
| Rate for Payer: Cash Price |
$10.08
|
| Rate for Payer: Cash Price |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$15.69
|
| Rate for Payer: Cigna of CA PPO |
$15.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.47
|
| Rate for Payer: Dignity Health Media |
$44.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.98
|
| Rate for Payer: Galaxy Health WC |
$19.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$73.76
|
| Rate for Payer: IEHP Medi-Cal |
$72.86
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$72.86
|
| Rate for Payer: IEHP Medicare Advantage |
$44.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$17.93
|
| Rate for Payer: Networks By Design Commercial |
$11.20
|
| Rate for Payer: Prime Health Services Commercial |
$19.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.20
|
| Rate for Payer: United Healthcare All Other HMO |
$11.20
|
| Rate for Payer: United Healthcare HMO Rider |
$11.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: Vantage Medical Group Senior |
$44.98
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
IP
|
$22.41
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG207352D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Blue Shield of California Commercial |
$15.96
|
| Rate for Payer: Blue Shield of California EPN |
$11.47
|
| Rate for Payer: Cash Price |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$15.69
|
| Rate for Payer: Cigna of CA PPO |
$15.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.96
|
| Rate for Payer: Galaxy Health WC |
$19.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.93
|
| Rate for Payer: Networks By Design Commercial |
$11.20
|
| Rate for Payer: Prime Health Services Commercial |
$19.05
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
IP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG108088C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$17.42 |
| Rate for Payer: Blue Shield of California Commercial |
$14.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.50
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$303.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.02
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.11
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: Dignity Health Media |
$48.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$79.20
|
| Rate for Payer: IEHP Medi-Cal |
$78.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$78.23
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG108088C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$303.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.02
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.11
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: Dignity Health Media |
$48.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$79.20
|
| Rate for Payer: IEHP Medi-Cal |
$78.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$78.23
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
IP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$17.42 |
| Rate for Payer: Blue Shield of California Commercial |
$14.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.50
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
IP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$17.42 |
| Rate for Payer: Blue Shield of California Commercial |
$14.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.50
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$303.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.02
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.11
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: Dignity Health Media |
$48.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$79.20
|
| Rate for Payer: IEHP Medi-Cal |
$78.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$78.23
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
IP
|
$11.21
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG210297B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Blue Shield of California Commercial |
$7.98
|
| Rate for Payer: Blue Shield of California EPN |
$5.74
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$7.85
|
| Rate for Payer: Cigna of CA PPO |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.48
|
| Rate for Payer: Galaxy Health WC |
$9.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$8.97
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.53
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
OP
|
$11.21
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG210297B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$282.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$282.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.87
|
| Rate for Payer: BCBS Transplant Transplant |
$6.73
|
| Rate for Payer: Blue Shield of California Commercial |
$8.26
|
| Rate for Payer: Blue Shield of California EPN |
$102.15
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$7.85
|
| Rate for Payer: Cigna of CA PPO |
$7.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.47
|
| Rate for Payer: Dignity Health Media |
$44.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.98
|
| Rate for Payer: Galaxy Health WC |
$9.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$73.76
|
| Rate for Payer: IEHP Medi-Cal |
$72.86
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$72.86
|
| Rate for Payer: IEHP Medicare Advantage |
$44.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$8.97
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: Vantage Medical Group Senior |
$44.98
|
|
|
IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107752]
|
Facility
IP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG107752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$8.41
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.57
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
|
|
IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107752]
|
Facility
OP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG107752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$313.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$313.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.02
|
| Rate for Payer: BCBS Transplant Transplant |
$9.86
|
| Rate for Payer: Blue Shield of California Commercial |
$12.11
|
| Rate for Payer: Blue Shield of California EPN |
$73.31
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.68
|
| Rate for Payer: Dignity Health Media |
$49.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.79
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.65
|
| Rate for Payer: Heritage Provider Network Transplant |
$81.65
|
| Rate for Payer: IEHP Medi-Cal |
$80.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$80.65
|
| Rate for Payer: IEHP Medicare Advantage |
$49.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.71
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: Vantage Medical Group Senior |
$49.79
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$374,849.14
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$287,548.75 |
| Max. Negotiated Rate |
$374,849.14 |
| Rate for Payer: IEHP Medi-Cal |
$287,548.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374,849.14
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$287,174.61
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$220,293.15 |
| Max. Negotiated Rate |
$287,174.61 |
| Rate for Payer: IEHP Medi-Cal |
$220,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287,174.61
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$230,574.63
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$176,875.01 |
| Max. Negotiated Rate |
$230,574.63 |
| Rate for Payer: IEHP Medi-Cal |
$176,875.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230,574.63
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$219,047.14
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$168,032.22 |
| Max. Negotiated Rate |
$219,047.14 |
| Rate for Payer: IEHP Medi-Cal |
$168,032.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219,047.14
|
|
|
Impression and custom preparation; oral surgical splint
|
Facility
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 21085
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,577.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$494.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$494.41
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
IP
|
$10,529.04
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$8,076.88 |
| Max. Negotiated Rate |
$10,529.04 |
| Rate for Payer: IEHP Medi-Cal |
$8,076.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,529.04
|
|
