|
Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 21501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: IEHP medi-cal |
$5,857.93
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Innovage PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health MISP |
$3,905.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 10061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$498.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single
|
Facility
OP
|
$5,779.00
|
|
|
Service Code
|
CPT 10060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
Incision and drainage of hematoma, seroma or fluid collection
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 10140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,025.69 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 46040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
Incision and drainage, perianal abscess, superficial
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 46050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,141.93 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: IEHP medi-cal |
$1,884.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Innovage PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health MISP |
$1,256.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
Incision and removal of foreign body, subcutaneous tissues; complicated
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 10121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,025.69 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Incision and removal of foreign body, subcutaneous tissues; simple
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 10120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$498.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
Incision, extensor tendon sheath, wrist (eg, de Quervains disease)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 25000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,008.09 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE [233001]
|
Facility
OP
|
$2,665.41
|
|
|
Service Code
|
CPT J1306
|
| Hospital Charge Code |
ERX233001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$2,398.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1,599.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,303.39
|
| Rate for Payer: Caremore Medicare Advantage |
$12.13
|
| Rate for Payer: Cash Price |
$1,199.43
|
| Rate for Payer: Cash Price |
$1,199.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,132.33
|
| Rate for Payer: Cigna of CA HMO |
$1,865.79
|
| Rate for Payer: Cigna of CA PPO |
$1,865.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.13
|
| Rate for Payer: Galaxy Health WC |
$2,265.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,599.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,398.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,999.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.90
|
| Rate for Payer: IEHP medi-cal |
$20.02
|
| Rate for Payer: IEHP Medicare Advantage |
$12.13
|
| Rate for Payer: Innovage PACE Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,777.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$1,999.06
|
| Rate for Payer: Networks By Design Commercial |
$1,332.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,265.60
|
| Rate for Payer: Prime Health Services Medicare |
$12.86
|
| Rate for Payer: Riverside University Health MISP |
$13.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,599.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,599.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,332.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,332.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13.35
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE [233001]
|
Facility
IP
|
$2,665.41
|
|
|
Service Code
|
CPT J1306
|
| Hospital Charge Code |
ERX233001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$533.08 |
| Max. Negotiated Rate |
$2,398.87 |
| Rate for Payer: Blue Shield of California Commercial |
$1,999.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,423.33
|
| Rate for Payer: Cash Price |
$1,199.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,132.33
|
| Rate for Payer: Cigna of CA HMO |
$1,865.79
|
| Rate for Payer: Cigna of CA PPO |
$1,865.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,066.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,066.16
|
| Rate for Payer: Galaxy Health WC |
$2,265.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,599.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,398.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,777.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.08
|
| Rate for Payer: Multiplan Commercial |
$1,999.06
|
| Rate for Payer: Networks By Design Commercial |
$1,332.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,265.60
|
|
|
INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION [105971]
|
Facility
OP
|
$595.20
|
|
|
Service Code
|
CPT J0588
|
| Hospital Charge Code |
ERX105971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.27
|
| Rate for Payer: BCBS Transplant Transplant |
$357.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6.47
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Caremore Medicare Advantage |
$5.19
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Central Health Plan Commercial |
$476.16
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$416.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.19
|
| Rate for Payer: Galaxy Health WC |
$505.92
|
| Rate for Payer: Global Benefits Group Commercial |
$357.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$446.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.51
|
| Rate for Payer: IEHP medi-cal |
$8.56
|
| Rate for Payer: IEHP Medicare Advantage |
$5.19
|
| Rate for Payer: Innovage PACE Commercial |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: Networks By Design Commercial |
$297.60
|
| Rate for Payer: Prime Health Services Commercial |
$505.92
|
| Rate for Payer: Prime Health Services Medicare |
$5.50
|
| Rate for Payer: Riverside University Health MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Other HMO |
$297.60
|
| Rate for Payer: United Healthcare HMO Rider |
$297.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.19
|
|
|
INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION [105971]
|
Facility
IP
|
$595.20
|
|
|
Service Code
|
CPT J0588
|
| Hospital Charge Code |
ERX105971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Blue Shield of California Commercial |
$446.40
|
| Rate for Payer: Blue Shield of California EPN |
$317.84
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Central Health Plan Commercial |
$476.16
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$416.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$238.08
|
| Rate for Payer: Galaxy Health WC |
$505.92
|
| Rate for Payer: Global Benefits Group Commercial |
$357.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: Networks By Design Commercial |
$297.60
|
| Rate for Payer: Prime Health Services Commercial |
$505.92
|
|
|
INDAPAMIDE 2.5 MG TABLET [3879]
|
Facility
OP
|
$0.74
|
|
|
Service Code
|
NDC 51079-868-01
|
| Hospital Charge Code |
1710672
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: IEHP medi-cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Riverside University Health MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
INDAPAMIDE 2.5 MG TABLET [3879]
|
Facility
IP
|
$0.74
|
|
|
Service Code
|
NDC 51079-868-01
|
| Hospital Charge Code |
1710672
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
INDIGOTINDISULFONATE 8 MG/ML (0.8 %) INJECTION SOLUTION [40810901]
|
Facility
OP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-01
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.72
|
| Rate for Payer: BCBS Transplant Transplant |
$27.13
|
| Rate for Payer: Blue Shield of California Commercial |
$28.44
|
| Rate for Payer: Blue Shield of California EPN |
$22.11
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: Cigna of CA HMO |
$28.94
|
| Rate for Payer: Cigna of CA PPO |
$33.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.92
|
| Rate for Payer: IEHP medi-cal |
$15.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
| Rate for Payer: Riverside University Health MISP |
$18.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22.61
|
| Rate for Payer: United Healthcare HMO Rider |
$22.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.44
|
| Rate for Payer: Vantage Medical Group Senior |
$38.44
|
|
|
INDIGOTINDISULFONATE 8 MG/ML (0.8 %) INJECTION SOLUTION [40810901]
|
Facility
IP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-01
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Blue Shield of California Commercial |
$33.92
|
| Rate for Payer: Blue Shield of California EPN |
$24.15
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
|
|
INDIGOTINDISULFONATE 8 MG/ML (0.8 %) INJECTION SOLUTION [40810901]
|
Facility
IP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-05
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Blue Shield of California Commercial |
$33.92
|
| Rate for Payer: Blue Shield of California EPN |
$24.15
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
|
|
INDIGOTINDISULFONATE 8 MG/ML (0.8 %) INJECTION SOLUTION [40810901]
|
Facility
OP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-05
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.72
|
| Rate for Payer: BCBS Transplant Transplant |
$27.13
|
| Rate for Payer: Blue Shield of California Commercial |
$28.44
|
| Rate for Payer: Blue Shield of California EPN |
$22.11
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: Cigna of CA HMO |
$28.94
|
| Rate for Payer: Cigna of CA PPO |
$33.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.92
|
| Rate for Payer: IEHP medi-cal |
$15.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
| Rate for Payer: Riverside University Health MISP |
$18.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22.61
|
| Rate for Payer: United Healthcare HMO Rider |
$22.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.44
|
| Rate for Payer: Vantage Medical Group Senior |
$38.44
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [110901]
|
Facility
IP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-01
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Blue Shield of California Commercial |
$33.92
|
| Rate for Payer: Blue Shield of California EPN |
$24.15
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [110901]
|
Facility
IP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-05
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Blue Shield of California Commercial |
$33.92
|
| Rate for Payer: Blue Shield of California EPN |
$24.15
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [110901]
|
Facility
OP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-01
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.72
|
| Rate for Payer: BCBS Transplant Transplant |
$27.13
|
| Rate for Payer: Blue Shield of California Commercial |
$28.44
|
| Rate for Payer: Blue Shield of California EPN |
$22.11
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: Cigna of CA HMO |
$28.94
|
| Rate for Payer: Cigna of CA PPO |
$33.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.92
|
| Rate for Payer: IEHP medi-cal |
$15.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
| Rate for Payer: Riverside University Health MISP |
$18.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22.61
|
| Rate for Payer: United Healthcare HMO Rider |
$22.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.44
|
| Rate for Payer: Vantage Medical Group Senior |
$38.44
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [110901]
|
Facility
OP
|
$45.22
|
|
|
Service Code
|
NDC 0517-0375-05
|
| Hospital Charge Code |
1720070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.72
|
| Rate for Payer: BCBS Transplant Transplant |
$27.13
|
| Rate for Payer: Blue Shield of California Commercial |
$28.44
|
| Rate for Payer: Blue Shield of California EPN |
$22.11
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$36.18
|
| Rate for Payer: Cigna of CA HMO |
$28.94
|
| Rate for Payer: Cigna of CA PPO |
$33.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.92
|
| Rate for Payer: IEHP medi-cal |
$15.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.92
|
| Rate for Payer: Networks By Design Commercial |
$29.39
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
| Rate for Payer: Riverside University Health MISP |
$18.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22.61
|
| Rate for Payer: United Healthcare HMO Rider |
$22.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.44
|
| Rate for Payer: Vantage Medical Group Senior |
$38.44
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [235583]
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
NDC 81284-315-05
|
| Hospital Charge Code |
NDG235583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.72
|
| Rate for Payer: BCBS Transplant Transplant |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$60.38
|
| Rate for Payer: Blue Shield of California EPN |
$46.94
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.00
|
| Rate for Payer: IEHP medi-cal |
$33.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Riverside University Health MISP |
$38.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [235583]
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
NDC 81284-315-00
|
| Hospital Charge Code |
NDG235583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Blue Shield of California Commercial |
$72.00
|
| Rate for Payer: Blue Shield of California EPN |
$51.26
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
