|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0093314705
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 0904733706
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 6068716301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 6068716311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6586201901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0093314705
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 6068716301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 5026815215
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6586201901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0600053797
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0600053797
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
|
OP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$6,803.35 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.88
|
| Rate for Payer: Blue Shield of California EPN |
$17.16
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Central Health Plan Commercial |
$6,047.42
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,803.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: Prime Health Services Medicare |
$3.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,535.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,535.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
|
IP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,511.86 |
| Max. Negotiated Rate |
$6,803.35 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6,062.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,809.88
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Central Health Plan Commercial |
$6,047.42
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,023.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3,023.71
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,803.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,459.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.86
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [97853]
|
Facility
|
IP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,511.86 |
| Max. Negotiated Rate |
$6,803.35 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6,062.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,809.88
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Central Health Plan Commercial |
$6,047.42
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,023.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3,023.71
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,803.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,459.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.86
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [97853]
|
Facility
|
OP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$6,803.35 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.88
|
| Rate for Payer: Blue Shield of California EPN |
$17.16
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Central Health Plan Commercial |
$6,047.42
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,803.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: Prime Health Services Medicare |
$3.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,535.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,535.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 38724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.17
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$77,538.41
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$22,650.00 |
| Max. Negotiated Rate |
$77,538.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77,538.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50,086.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70,123.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$68,531.66
|
| Rate for Payer: EPIC Health Plan Senior |
$45,687.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,534.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58,148.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55,656.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41,534.34
|
| Rate for Payer: Prime Health Services Medicare |
$44,026.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$30,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24,721.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,650.00
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$127,086.56
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$24,564.00 |
| Max. Negotiated Rate |
$127,086.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127,086.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82,092.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114,932.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,373.78
|
| Rate for Payer: EPIC Health Plan Senior |
$74,249.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,499.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,498.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90,449.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67,499.26
|
| Rate for Payer: Prime Health Services Medicare |
$71,549.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,108.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31,692.00
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$64,252.57
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$22,963.00 |
| Max. Negotiated Rate |
$64,252.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,252.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,504.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58,107.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,044.01
|
| Rate for Payer: EPIC Health Plan Senior |
$38,029.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,572.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,400.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,326.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,572.13
|
| Rate for Payer: Prime Health Services Medicare |
$36,646.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,292.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,292.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,963.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$40,000.51
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$25,263.48 |
| Max. Negotiated Rate |
$40,000.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,263.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,000.51
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$17,782.48
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$11,231.04 |
| Max. Negotiated Rate |
$17,782.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,231.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,383.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,782.48
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$10,240.54
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$6,467.71 |
| Max. Negotiated Rate |
$10,240.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,467.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,707.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,240.54
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$12,921.42
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$8,160.90 |
| Max. Negotiated Rate |
$12,921.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,160.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,725.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,921.42
|
|
