|
Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 50391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| 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 |
$308.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: IEHP medi-cal |
$509.50
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Innovage PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health MISP |
$339.67
|
| 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 |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
OP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.37
|
| 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 |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.58
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Central Health Plan Commercial |
$32.54
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.50
|
| Rate for Payer: IEHP medi-cal |
$14.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: Riverside University Health MISP |
$16.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$20.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
IP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Blue Shield of California Commercial |
$30.50
|
| Rate for Payer: Blue Shield of California EPN |
$21.72
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Central Health Plan Commercial |
$32.54
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
OP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.28
|
| 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 |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$22.05
|
| Rate for Payer: Blue Shield of California EPN |
$17.14
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Central Health Plan Commercial |
$28.04
|
| Rate for Payer: Cigna of CA HMO |
$24.54
|
| Rate for Payer: Cigna of CA PPO |
$24.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.02
|
| Rate for Payer: Galaxy Health WC |
$29.79
|
| Rate for Payer: Global Benefits Group Commercial |
$21.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.29
|
| Rate for Payer: IEHP medi-cal |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$26.29
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$29.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.03
|
| Rate for Payer: Riverside University Health MISP |
$14.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.52
|
| Rate for Payer: United Healthcare All Other HMO |
$17.52
|
| Rate for Payer: United Healthcare HMO Rider |
$17.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Vantage Medical Group Senior |
$29.79
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
IP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Blue Shield of California EPN |
$18.72
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Central Health Plan Commercial |
$28.04
|
| Rate for Payer: Cigna of CA HMO |
$24.54
|
| Rate for Payer: Cigna of CA PPO |
$24.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: Galaxy Health WC |
$29.79
|
| Rate for Payer: Global Benefits Group Commercial |
$21.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$26.29
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$29.79
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
OP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.83
|
| Rate for Payer: BCBS Transplant Transplant |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$16.85
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Central Health Plan Commercial |
$21.43
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.09
|
| Rate for Payer: IEHP medi-cal |
$9.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$20.09
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: Riverside University Health MISP |
$10.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
IP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Blue Shield of California Commercial |
$20.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.31
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Central Health Plan Commercial |
$21.43
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$20.09
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
IP
|
$34.07
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.66 |
| Rate for Payer: Blue Shield of California Commercial |
$25.55
|
| Rate for Payer: Blue Shield of California EPN |
$18.19
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Central Health Plan Commercial |
$27.26
|
| Rate for Payer: Cigna of CA HMO |
$23.85
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$28.96
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.15
|
| Rate for Payer: Prime Health Services Commercial |
$28.96
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
OP
|
$34.07
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.13
|
| Rate for Payer: BCBS Transplant Transplant |
$20.44
|
| Rate for Payer: Blue Shield of California Commercial |
$21.43
|
| Rate for Payer: Blue Shield of California EPN |
$16.66
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Central Health Plan Commercial |
$27.26
|
| Rate for Payer: Cigna of CA HMO |
$23.85
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$28.96
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.55
|
| Rate for Payer: IEHP medi-cal |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.15
|
| Rate for Payer: Prime Health Services Commercial |
$28.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: Riverside University Health MISP |
$13.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.04
|
| Rate for Payer: United Healthcare All Other HMO |
$17.04
|
| Rate for Payer: United Healthcare HMO Rider |
$17.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.96
|
| Rate for Payer: Vantage Medical Group Senior |
$28.96
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
NDG225937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
NDG225937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
OP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-01
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$103.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$63.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$63.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.85
|
| Rate for Payer: BCBS Transplant Transplant |
$68.90
|
| Rate for Payer: Blue Shield of California Commercial |
$72.23
|
| Rate for Payer: Blue Shield of California EPN |
$56.16
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Central Health Plan Commercial |
$91.87
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$86.13
|
| Rate for Payer: IEHP medi-cal |
$40.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$86.13
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: Riverside University Health MISP |
$45.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$57.42
|
| Rate for Payer: United Healthcare HMO Rider |
$57.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.61
|
| Rate for Payer: Vantage Medical Group Senior |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
OP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-27
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$103.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$63.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$63.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.85
|
| Rate for Payer: BCBS Transplant Transplant |
$68.90
|
| Rate for Payer: Blue Shield of California Commercial |
$72.23
|
| Rate for Payer: Blue Shield of California EPN |
$56.16
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Central Health Plan Commercial |
$91.87
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$86.13
|
| Rate for Payer: IEHP medi-cal |
$40.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$86.13
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: Riverside University Health MISP |
$45.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$57.42
|
| Rate for Payer: United Healthcare HMO Rider |
$57.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.61
|
| Rate for Payer: Vantage Medical Group Senior |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
IP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-01
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$103.36 |
| Rate for Payer: Blue Shield of California Commercial |
$86.13
|
| Rate for Payer: Blue Shield of California EPN |
$61.32
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Central Health Plan Commercial |
$91.87
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$86.13
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
IP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-27
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$103.36 |
| Rate for Payer: Blue Shield of California Commercial |
$86.13
|
| Rate for Payer: Blue Shield of California EPN |
$61.32
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Central Health Plan Commercial |
$91.87
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$86.13
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
IP
|
$4,552.88
|
|
|
Service Code
|
APR-DRG 8171
|
| Min. Negotiated Rate |
$3,820.60 |
| Max. Negotiated Rate |
$4,552.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,820.60
|
| Rate for Payer: IEHP medi-cal |
$4,552.88
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
IP
|
$5,739.48
|
|
|
Service Code
|
APR-DRG 8172
|
| Min. Negotiated Rate |
$4,816.34 |
| Max. Negotiated Rate |
$5,739.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,816.34
|
| Rate for Payer: IEHP medi-cal |
$5,739.48
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
IP
|
$9,325.99
|
|
|
Service Code
|
APR-DRG 8173
|
| Min. Negotiated Rate |
$7,826.00 |
| Max. Negotiated Rate |
$9,325.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,826.00
|
| Rate for Payer: IEHP medi-cal |
$9,325.99
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
IP
|
$16,931.46
|
|
|
Service Code
|
APR-DRG 8174
|
| Min. Negotiated Rate |
$14,208.22 |
| Max. Negotiated Rate |
$16,931.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,208.22
|
| Rate for Payer: IEHP medi-cal |
$16,931.46
|
|
|
Interdental wiring, for condition other than fracture
|
Facility
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 21497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.44 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| 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 |
$1,905.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| 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 |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
IP
|
$7,347.87
|
|
|
Service Code
|
APR-DRG 1421
|
| Min. Negotiated Rate |
$6,166.04 |
| Max. Negotiated Rate |
$7,347.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,166.04
|
| Rate for Payer: IEHP medi-cal |
$7,347.87
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
IP
|
$11,715.20
|
|
|
Service Code
|
APR-DRG 1423
|
| Min. Negotiated Rate |
$9,830.94 |
| Max. Negotiated Rate |
$11,715.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,830.94
|
| Rate for Payer: IEHP medi-cal |
$11,715.20
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
IP
|
$8,651.93
|
|
|
Service Code
|
APR-DRG 1422
|
| Min. Negotiated Rate |
$7,260.36 |
| Max. Negotiated Rate |
$8,651.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,260.36
|
| Rate for Payer: IEHP medi-cal |
$8,651.93
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
IP
|
$17,664.25
|
|
|
Service Code
|
APR-DRG 1424
|
| Min. Negotiated Rate |
$14,823.14 |
| Max. Negotiated Rate |
$17,664.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,823.14
|
| Rate for Payer: IEHP medi-cal |
$17,664.25
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
IP
|
$5,615.34
|
|
|
Service Code
|
APR-DRG 2471
|
| Min. Negotiated Rate |
$4,712.17 |
| Max. Negotiated Rate |
$5,615.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,712.17
|
| Rate for Payer: IEHP medi-cal |
$5,615.34
|
|
