|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
IP
|
$1,896.07
|
|
|
Service Code
|
NDC 68817-134-50
|
| Hospital Charge Code |
1755722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.06 |
| Max. Negotiated Rate |
$1,611.66 |
| Rate for Payer: Blue Shield of California Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California EPN |
$970.79
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cigna of CA HMO |
$1,327.25
|
| Rate for Payer: Cigna of CA PPO |
$1,327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$758.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$758.43
|
| Rate for Payer: Galaxy Health WC |
$1,611.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,137.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,264.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.06
|
| Rate for Payer: Multiplan Commercial |
$1,516.86
|
| Rate for Payer: Networks By Design Commercial |
$948.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,611.66
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
OP
|
$1,896.07
|
|
|
Service Code
|
NDC 68817-134-50
|
| Hospital Charge Code |
1755722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.06 |
| Max. Negotiated Rate |
$1,611.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,243.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,042.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,042.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,129.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1,137.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,107.30
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cash Price |
$853.23
|
| Rate for Payer: Cigna of CA HMO |
$1,327.25
|
| Rate for Payer: Cigna of CA PPO |
$1,327.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.66
|
| Rate for Payer: Dignity Health Media |
$1,611.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,611.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$758.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$758.43
|
| Rate for Payer: Galaxy Health WC |
$1,611.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,137.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,422.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,264.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.06
|
| Rate for Payer: Multiplan Commercial |
$1,516.86
|
| Rate for Payer: Networks By Design Commercial |
$948.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,611.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,137.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,137.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$948.04
|
| Rate for Payer: United Healthcare All Other HMO |
$948.04
|
| Rate for Payer: United Healthcare HMO Rider |
$948.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$948.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,611.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,611.66
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
OP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$3,188.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$199.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.45
|
| Rate for Payer: BCBS Transplant Transplant |
$2,250.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,764.68
|
| Rate for Payer: Blue Shield of California EPN |
$25.90
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cigna of CA HMO |
$2,625.88
|
| Rate for Payer: Cigna of CA PPO |
$2,625.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.76
|
| Rate for Payer: Dignity Health Media |
$26.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.51
|
| Rate for Payer: Galaxy Health WC |
$3,188.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2,250.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,813.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$43.47
|
| Rate for Payer: IEHP Medi-Cal |
$42.94
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$42.94
|
| Rate for Payer: IEHP Medicare Advantage |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$3,001.01
|
| Rate for Payer: Networks By Design Commercial |
$1,875.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,188.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,250.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,250.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,875.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,875.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,875.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: Vantage Medical Group Senior |
$26.51
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
IP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.30 |
| Max. Negotiated Rate |
$3,188.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2,670.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,920.65
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cigna of CA HMO |
$2,625.88
|
| Rate for Payer: Cigna of CA PPO |
$2,625.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,500.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,500.50
|
| Rate for Payer: Galaxy Health WC |
$3,188.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2,250.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,429.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.30
|
| Rate for Payer: Multiplan Commercial |
$3,001.01
|
| Rate for Payer: Networks By Design Commercial |
$1,875.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,188.57
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
OP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$2,276.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1,607.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.11
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cigna of CA HMO |
$1,875.00
|
| Rate for Payer: Cigna of CA PPO |
$1,875.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Media |
$14.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$2,276.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,008.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.48
|
| Rate for Payer: IEHP Medi-Cal |
$23.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$23.20
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$2,142.86
|
| Rate for Payer: Networks By Design Commercial |
$1,339.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,607.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,607.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
IP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$642.86 |
| Max. Negotiated Rate |
$2,276.78 |
| Rate for Payer: Blue Shield of California Commercial |
$1,907.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,371.43
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cigna of CA HMO |
$1,875.00
|
| Rate for Payer: Cigna of CA PPO |
$1,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,071.43
|
| Rate for Payer: Galaxy Health WC |
$2,276.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.86
|
| Rate for Payer: Multiplan Commercial |
$2,142.86
|
| Rate for Payer: Networks By Design Commercial |
$1,339.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.78
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
OP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$2,276.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1,607.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.05
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cigna of CA HMO |
$1,874.95
|
| Rate for Payer: Cigna of CA PPO |
$1,874.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Media |
$14.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$2,276.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,008.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.48
|
| Rate for Payer: IEHP Medi-Cal |
$23.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$23.20
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$2,142.80
|
| Rate for Payer: Networks By Design Commercial |
$1,339.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,607.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,607.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
IP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$642.84 |
| Max. Negotiated Rate |
$2,276.72 |
| Rate for Payer: Blue Shield of California Commercial |
$1,907.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,371.39
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cigna of CA HMO |
$1,874.95
|
| Rate for Payer: Cigna of CA PPO |
$1,874.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,071.40
|
| Rate for Payer: Galaxy Health WC |
$2,276.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,607.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.84
|
| Rate for Payer: Multiplan Commercial |
$2,142.80
|
| Rate for Payer: Networks By Design Commercial |
$1,339.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.72
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
IP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$990.12 |
| Max. Negotiated Rate |
$3,506.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2,937.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,112.26
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cigna of CA HMO |
$2,887.85
|
| Rate for Payer: Cigna of CA PPO |
$2,887.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,650.20
|
| Rate for Payer: Galaxy Health WC |
$3,506.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.12
|
| Rate for Payer: Multiplan Commercial |
$3,300.40
|
| Rate for Payer: Networks By Design Commercial |
$2,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.68
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
OP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$12,910.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,910.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$373.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,258.51
|
| Rate for Payer: BCBS Transplant Transplant |
$2,475.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,835.14
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cigna of CA HMO |
$2,887.85
|
| Rate for Payer: Cigna of CA PPO |
$2,887.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.52
|
| Rate for Payer: Dignity Health Media |
$339.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$339.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$339.68
|
| Rate for Payer: Galaxy Health WC |
$3,506.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,094.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$557.08
|
| Rate for Payer: IEHP Medi-Cal |
$550.28
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$550.28
|
| Rate for Payer: IEHP Medicare Advantage |
$339.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,371.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$428.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.17
|
| Rate for Payer: Multiplan Commercial |
$3,300.40
|
| Rate for Payer: Networks By Design Commercial |
$2,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: Vantage Medical Group Senior |
$339.68
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00984ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00C84ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00C80ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00B84ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00980ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00880ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00583ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00580ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00884ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00883ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00B83ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00584ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00983ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 00C83ZZ
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
|
Pallidotomy
|
Facility
IP
|
$12,866.00
|
|
|
Service Code
|
ICD 009830Z
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Heritage Provider Network Commercial |
$12,866.00
|
| Rate for Payer: Networks By Design Commercial |
$10,000.00
|
|
