|
ADRENAL PROCEDURES
|
Facility
IP
|
$34,135.20
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$28,644.92 |
| Max. Negotiated Rate |
$34,135.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,644.92
|
| Rate for Payer: IEHP medi-cal |
$34,135.20
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
OP
|
$44,400.00
|
|
|
Service Code
|
CPT J0178
|
| Hospital Charge Code |
NDG152966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$862.28 |
| Max. Negotiated Rate |
$39,960.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$862.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,343.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,077.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$948.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$948.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,830.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,004.33
|
| Rate for Payer: BCBS Transplant Transplant |
$26,640.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,110.00
|
| Rate for Payer: Caremore Medicare Advantage |
$862.28
|
| Rate for Payer: Cash Price |
$19,980.00
|
| Rate for Payer: Cash Price |
$19,980.00
|
| Rate for Payer: Central Health Plan Commercial |
$35,520.00
|
| Rate for Payer: Cigna of CA HMO |
$31,080.00
|
| Rate for Payer: Cigna of CA PPO |
$31,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,293.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,164.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$862.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$862.28
|
| Rate for Payer: Galaxy Health WC |
$37,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$26,640.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,960.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33,300.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,414.14
|
| Rate for Payer: IEHP medi-cal |
$1,422.76
|
| Rate for Payer: IEHP Medicare Advantage |
$862.28
|
| Rate for Payer: Innovage PACE Commercial |
$1,293.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,614.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,880.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,155.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,155.46
|
| Rate for Payer: Multiplan Commercial |
$33,300.00
|
| Rate for Payer: Networks By Design Commercial |
$22,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$37,740.00
|
| Rate for Payer: Prime Health Services Medicare |
$914.02
|
| Rate for Payer: Riverside University Health MISP |
$948.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,640.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,200.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22,200.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22,200.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,200.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,293.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.51
|
| Rate for Payer: Vantage Medical Group Senior |
$862.28
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
IP
|
$44,400.00
|
|
|
Service Code
|
CPT J0178
|
| Hospital Charge Code |
NDG152966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,880.00 |
| Max. Negotiated Rate |
$39,960.00 |
| Rate for Payer: Blue Shield of California Commercial |
$33,300.00
|
| Rate for Payer: Blue Shield of California EPN |
$23,709.60
|
| Rate for Payer: Cash Price |
$19,980.00
|
| Rate for Payer: Central Health Plan Commercial |
$35,520.00
|
| Rate for Payer: Cigna of CA HMO |
$31,080.00
|
| Rate for Payer: Cigna of CA PPO |
$31,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,760.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$17,760.00
|
| Rate for Payer: Galaxy Health WC |
$37,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$26,640.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,614.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,880.00
|
| Rate for Payer: Multiplan Commercial |
$33,300.00
|
| Rate for Payer: Networks By Design Commercial |
$22,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$37,740.00
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
OP
|
$8,685.12
|
|
|
Service Code
|
CPT J0180
|
| Hospital Charge Code |
1755755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.32 |
| Max. Negotiated Rate |
$7,816.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$218.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,353.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$272.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$240.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$240.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.86
|
| Rate for Payer: BCBS Transplant Transplant |
$5,211.07
|
| Rate for Payer: Blue Shield of California Commercial |
$235.75
|
| Rate for Payer: Blue Shield of California EPN |
$214.32
|
| Rate for Payer: Caremore Medicare Advantage |
$218.34
|
| Rate for Payer: Cash Price |
$3,908.30
|
| Rate for Payer: Cash Price |
$3,908.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,948.10
|
| Rate for Payer: Cigna of CA HMO |
$6,079.58
|
| Rate for Payer: Cigna of CA PPO |
$6,079.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$218.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$218.34
|
| Rate for Payer: Galaxy Health WC |
$7,382.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,211.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,816.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,513.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$358.08
|
| Rate for Payer: IEHP medi-cal |
$360.26
|
| Rate for Payer: IEHP Medicare Advantage |
$218.34
|
| Rate for Payer: Innovage PACE Commercial |
$327.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,792.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,737.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.58
|
| Rate for Payer: Multiplan Commercial |
$6,513.84
|
| Rate for Payer: Networks By Design Commercial |
$4,342.56
|
| Rate for Payer: Prime Health Services Commercial |
$7,382.35
|
| Rate for Payer: Prime Health Services Medicare |
$231.44
|
| Rate for Payer: Riverside University Health MISP |
$240.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,211.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,211.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,342.56
|
| Rate for Payer: United Healthcare All Other HMO |
$4,342.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4,342.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,342.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.18
|
| Rate for Payer: Vantage Medical Group Senior |
$218.34
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
IP
|
$8,685.12
|
|
|
Service Code
|
CPT J0180
|
| Hospital Charge Code |
1755755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,737.02 |
| Max. Negotiated Rate |
$7,816.61 |
| Rate for Payer: Blue Shield of California Commercial |
$6,513.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,637.85
|
| Rate for Payer: Cash Price |
$3,908.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,948.10
|
| Rate for Payer: Cigna of CA HMO |
$6,079.58
|
| Rate for Payer: Cigna of CA PPO |
$6,079.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,474.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,474.05
|
| Rate for Payer: Galaxy Health WC |
$7,382.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,211.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,816.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,792.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,737.02
|
| Rate for Payer: Multiplan Commercial |
$6,513.84
|
| Rate for Payer: Networks By Design Commercial |
$4,342.56
|
| Rate for Payer: Prime Health Services Commercial |
$7,382.35
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
OP
|
$1,240.52
|
|
|
Service Code
|
CPT J0180
|
| Hospital Charge Code |
1755754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.32 |
| Max. Negotiated Rate |
$1,353.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$218.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,353.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$272.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$240.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$240.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.86
|
| Rate for Payer: BCBS Transplant Transplant |
$744.31
|
| Rate for Payer: Blue Shield of California Commercial |
$235.75
|
| Rate for Payer: Blue Shield of California EPN |
$214.32
|
| Rate for Payer: Caremore Medicare Advantage |
$218.34
|
| Rate for Payer: Cash Price |
$558.23
|
| Rate for Payer: Cash Price |
$558.23
|
| Rate for Payer: Central Health Plan Commercial |
$992.42
|
| Rate for Payer: Cigna of CA HMO |
$868.36
|
| Rate for Payer: Cigna of CA PPO |
$868.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$218.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$218.34
|
| Rate for Payer: Galaxy Health WC |
$1,054.44
|
| Rate for Payer: Global Benefits Group Commercial |
$744.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,116.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$930.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$358.08
|
| Rate for Payer: IEHP medi-cal |
$360.26
|
| Rate for Payer: IEHP Medicare Advantage |
$218.34
|
| Rate for Payer: Innovage PACE Commercial |
$327.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.58
|
| Rate for Payer: Multiplan Commercial |
$930.39
|
| Rate for Payer: Networks By Design Commercial |
$620.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.44
|
| Rate for Payer: Prime Health Services Medicare |
$231.44
|
| Rate for Payer: Riverside University Health MISP |
$240.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$744.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$744.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$620.26
|
| Rate for Payer: United Healthcare All Other HMO |
$620.26
|
| Rate for Payer: United Healthcare HMO Rider |
$620.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.18
|
| Rate for Payer: Vantage Medical Group Senior |
$218.34
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
IP
|
$1,240.52
|
|
|
Service Code
|
CPT J0180
|
| Hospital Charge Code |
1755754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.10 |
| Max. Negotiated Rate |
$1,116.47 |
| Rate for Payer: Blue Shield of California Commercial |
$930.39
|
| Rate for Payer: Blue Shield of California EPN |
$662.44
|
| Rate for Payer: Cash Price |
$558.23
|
| Rate for Payer: Central Health Plan Commercial |
$992.42
|
| Rate for Payer: Cigna of CA HMO |
$868.36
|
| Rate for Payer: Cigna of CA PPO |
$868.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$496.21
|
| Rate for Payer: Galaxy Health WC |
$1,054.44
|
| Rate for Payer: Global Benefits Group Commercial |
$744.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,116.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.10
|
| Rate for Payer: Multiplan Commercial |
$930.39
|
| Rate for Payer: Networks By Design Commercial |
$620.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.44
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 9999-9226-41
|
| Hospital Charge Code |
1713148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 9999-9226-41
|
| Hospital Charge Code |
1713148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
NDC 31722-935-02
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.27
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.64
|
| Rate for Payer: Blue Shield of California EPN |
$17.60
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: IEHP medi-cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: Riverside University Health MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
NDC 31722-935-02
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Blue Shield of California Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California EPN |
$19.22
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
OP
|
$35.85
|
|
|
Service Code
|
NDC 72205-051-08
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$32.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.18
|
| Rate for Payer: BCBS Transplant Transplant |
$21.51
|
| Rate for Payer: Blue Shield of California Commercial |
$22.55
|
| Rate for Payer: Blue Shield of California EPN |
$17.53
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Central Health Plan Commercial |
$28.68
|
| Rate for Payer: Cigna of CA HMO |
$25.10
|
| Rate for Payer: Cigna of CA PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.34
|
| Rate for Payer: Galaxy Health WC |
$30.47
|
| Rate for Payer: Global Benefits Group Commercial |
$21.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.89
|
| Rate for Payer: IEHP medi-cal |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
| Rate for Payer: Networks By Design Commercial |
$23.30
|
| Rate for Payer: Prime Health Services Commercial |
$30.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.51
|
| Rate for Payer: Riverside University Health MISP |
$14.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.92
|
| Rate for Payer: United Healthcare All Other HMO |
$17.92
|
| Rate for Payer: United Healthcare HMO Rider |
$17.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.47
|
| Rate for Payer: Vantage Medical Group Senior |
$30.47
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
IP
|
$35.85
|
|
|
Service Code
|
NDC 72205-051-08
|
| Hospital Charge Code |
1712227
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$32.26 |
| Rate for Payer: Blue Shield of California Commercial |
$26.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.14
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Central Health Plan Commercial |
$28.68
|
| Rate for Payer: Cigna of CA HMO |
$25.10
|
| Rate for Payer: Cigna of CA PPO |
$25.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.34
|
| Rate for Payer: Galaxy Health WC |
$30.47
|
| Rate for Payer: Global Benefits Group Commercial |
$21.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
| Rate for Payer: Networks By Design Commercial |
$23.30
|
| Rate for Payer: Prime Health Services Commercial |
$30.47
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Caremore Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.08
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$87.05
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP medi-cal |
$87.58
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Innovage PACE Commercial |
$79.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.12
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Prime Health Services Medicare |
$56.26
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Riverside University Health MISP |
$58.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
IP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
OP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$10.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.65
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Caremore Medicare Advantage |
$10.62
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.62
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.41
|
| Rate for Payer: IEHP medi-cal |
$17.51
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: Innovage PACE Commercial |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.22
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Medicare |
$11.25
|
| Rate for Payer: Riverside University Health MISP |
$11.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
