|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$20,680.80
|
|
|
Service Code
|
APR-DRG 8934
|
| Min. Negotiated Rate |
$17,354.52 |
| Max. Negotiated Rate |
$20,680.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,354.52
|
| Rate for Payer: IEHP medi-cal |
$20,680.80
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$13,547.83
|
|
|
Service Code
|
APR-DRG 8933
|
| Min. Negotiated Rate |
$11,368.81 |
| Max. Negotiated Rate |
$13,547.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,368.81
|
| Rate for Payer: IEHP medi-cal |
$13,547.83
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$8,960.25
|
|
|
Service Code
|
APR-DRG 8931
|
| Min. Negotiated Rate |
$7,519.09 |
| Max. Negotiated Rate |
$8,960.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,519.09
|
| Rate for Payer: IEHP medi-cal |
$8,960.25
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$9,705.05
|
|
|
Service Code
|
APR-DRG 8932
|
| Min. Negotiated Rate |
$8,144.10 |
| Max. Negotiated Rate |
$9,705.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,144.10
|
| Rate for Payer: IEHP medi-cal |
$9,705.05
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$6,605.74
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$5,543.28 |
| Max. Negotiated Rate |
$6,605.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,543.28
|
| Rate for Payer: IEHP medi-cal |
$6,605.74
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$8,267.52
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$6,937.78 |
| Max. Negotiated Rate |
$8,267.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,937.78
|
| Rate for Payer: IEHP medi-cal |
$8,267.52
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$11,960.81
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$10,037.04 |
| Max. Negotiated Rate |
$11,960.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,037.04
|
| Rate for Payer: IEHP medi-cal |
$11,960.81
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$18,485.12
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$15,511.99 |
| Max. Negotiated Rate |
$18,485.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,511.99
|
| Rate for Payer: IEHP medi-cal |
$18,485.12
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
IP
|
$8.04
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
OP
|
$8.04
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.75
|
| Rate for Payer: BCBS Transplant Transplant |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.03
|
| Rate for Payer: IEHP medi-cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
IP
|
$643.26
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
NDG208396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$578.93 |
| Rate for Payer: Blue Shield of California Commercial |
$482.44
|
| Rate for Payer: Blue Shield of California EPN |
$343.50
|
| Rate for Payer: Cash Price |
$289.47
|
| Rate for Payer: Central Health Plan Commercial |
$514.61
|
| Rate for Payer: Cigna of CA HMO |
$450.28
|
| Rate for Payer: Cigna of CA PPO |
$450.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.30
|
| Rate for Payer: Galaxy Health WC |
$546.77
|
| Rate for Payer: Global Benefits Group Commercial |
$385.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.65
|
| Rate for Payer: Multiplan Commercial |
$482.44
|
| Rate for Payer: Networks By Design Commercial |
$321.63
|
| Rate for Payer: Prime Health Services Commercial |
$546.77
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
OP
|
$643.26
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
NDG208396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$1,798.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,798.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$546.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$353.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$353.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.15
|
| Rate for Payer: BCBS Transplant Transplant |
$385.96
|
| Rate for Payer: Blue Shield of California Commercial |
$315.70
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$289.47
|
| Rate for Payer: Cash Price |
$289.47
|
| Rate for Payer: Central Health Plan Commercial |
$514.61
|
| Rate for Payer: Cigna of CA HMO |
$450.28
|
| Rate for Payer: Cigna of CA PPO |
$450.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.30
|
| Rate for Payer: Galaxy Health WC |
$546.77
|
| Rate for Payer: Global Benefits Group Commercial |
$385.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$482.44
|
| Rate for Payer: IEHP medi-cal |
$225.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.65
|
| Rate for Payer: Multiplan Commercial |
$482.44
|
| Rate for Payer: Networks By Design Commercial |
$321.63
|
| Rate for Payer: Prime Health Services Commercial |
$546.77
|
| Rate for Payer: Riverside University Health MISP |
$257.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.63
|
| Rate for Payer: United Healthcare All Other HMO |
$321.63
|
| Rate for Payer: United Healthcare HMO Rider |
$321.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.77
|
| Rate for Payer: Vantage Medical Group Senior |
$546.77
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [206243]
|
Facility
IP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX206243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.91
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Central Health Plan Commercial |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [206243]
|
Facility
OP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX206243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.90
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Caremore Medicare Advantage |
$2.28
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Central Health Plan Commercial |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.74
|
| Rate for Payer: IEHP medi-cal |
$3.76
|
| Rate for Payer: IEHP Medicare Advantage |
$2.28
|
| Rate for Payer: Innovage PACE Commercial |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Medicare |
$2.42
|
| Rate for Payer: Riverside University Health MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.28
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
OP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX205938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.90
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Caremore Medicare Advantage |
$2.28
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Central Health Plan Commercial |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.74
|
| Rate for Payer: IEHP medi-cal |
$3.76
|
| Rate for Payer: IEHP Medicare Advantage |
$2.28
|
| Rate for Payer: Innovage PACE Commercial |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Medicare |
$2.42
|
| Rate for Payer: Riverside University Health MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.28
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
IP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX205938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.91
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Central Health Plan Commercial |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
OP
|
$66.96
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
1721178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$40.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Central Health Plan Commercial |
$53.57
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$50.22
|
| Rate for Payer: IEHP medi-cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
| Rate for Payer: Riverside University Health MISP |
$26.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.48
|
| Rate for Payer: United Healthcare All Other HMO |
$33.48
|
| Rate for Payer: United Healthcare HMO Rider |
$33.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.92
|
| Rate for Payer: Vantage Medical Group Senior |
$56.92
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
IP
|
$66.96
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
1721178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Blue Shield of California Commercial |
$50.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.76
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Central Health Plan Commercial |
$53.57
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
|
|
HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]
|
Facility
IP
|
$120.83
|
|
|
Service Code
|
CPT J3471
|
| Hospital Charge Code |
1721153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Blue Shield of California Commercial |
$90.62
|
| Rate for Payer: Blue Shield of California EPN |
$64.52
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Central Health Plan Commercial |
$96.66
|
| Rate for Payer: Cigna of CA HMO |
$84.58
|
| Rate for Payer: Cigna of CA PPO |
$84.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.33
|
| Rate for Payer: Galaxy Health WC |
$102.71
|
| Rate for Payer: Global Benefits Group Commercial |
$72.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.17
|
| Rate for Payer: Multiplan Commercial |
$90.62
|
| Rate for Payer: Networks By Design Commercial |
$60.42
|
| Rate for Payer: Prime Health Services Commercial |
$102.71
|
|
|
HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]
|
Facility
OP
|
$120.83
|
|
|
Service Code
|
CPT J3471
|
| Hospital Charge Code |
1721153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$72.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Central Health Plan Commercial |
$96.66
|
| Rate for Payer: Cigna of CA HMO |
$84.58
|
| Rate for Payer: Cigna of CA PPO |
$84.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.33
|
| Rate for Payer: Galaxy Health WC |
$102.71
|
| Rate for Payer: Global Benefits Group Commercial |
$72.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.62
|
| Rate for Payer: IEHP medi-cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.17
|
| Rate for Payer: Multiplan Commercial |
$90.62
|
| Rate for Payer: Networks By Design Commercial |
$60.42
|
| Rate for Payer: Prime Health Services Commercial |
$102.71
|
| Rate for Payer: Riverside University Health MISP |
$48.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.42
|
| Rate for Payer: United Healthcare All Other HMO |
$60.42
|
| Rate for Payer: United Healthcare HMO Rider |
$60.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.71
|
| Rate for Payer: Vantage Medical Group Senior |
$102.71
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 23155-001-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare 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 |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-20
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 23155-001-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
