|
KIT FOR TC 99M-LABELED RED BLOOD CELLS INTRAVENOUS SOLUTION [225270]
|
Facility
|
IP
|
$181.13
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
ERX225270
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$163.02 |
| Rate for Payer: Blue Shield of California Commercial |
$135.85
|
| Rate for Payer: Blue Shield of California EPN |
$96.72
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Central Health Plan Commercial |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.45
|
| Rate for Payer: Galaxy Health WC |
$153.96
|
| Rate for Payer: Global Benefits Group Commercial |
$108.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.23
|
| Rate for Payer: Multiplan Commercial |
$135.85
|
| Rate for Payer: Networks By Design Commercial |
$117.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.39
|
| Rate for Payer: United Healthcare All Other HMO |
$66.80
|
| Rate for Payer: United Healthcare HMO Rider |
$65.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.77
|
|
|
KIT FOR TC 99M-LABELED RED BLOOD CELLS INTRAVENOUS SOLUTION [225270]
|
Facility
|
OP
|
$181.13
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
ERX225270
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$228.73 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.73
|
| Rate for Payer: Blue Distinction Transplant |
$108.68
|
| Rate for Payer: Blue Shield of California Commercial |
$111.94
|
| Rate for Payer: Blue Shield of California EPN |
$88.03
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Central Health Plan Commercial |
$144.90
|
| Rate for Payer: Cigna of CA HMO |
$115.92
|
| Rate for Payer: Cigna of CA PPO |
$134.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.96
|
| Rate for Payer: Dignity Health Media |
$153.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.45
|
| Rate for Payer: Galaxy Health WC |
$153.96
|
| Rate for Payer: Global Benefits Group Commercial |
$108.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$135.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.23
|
| Rate for Payer: Multiplan Commercial |
$135.85
|
| Rate for Payer: Networks By Design Commercial |
$117.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.96
|
| Rate for Payer: Riverside University Health System MISP |
$72.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.56
|
| Rate for Payer: United Healthcare All Other HMO |
$90.56
|
| Rate for Payer: United Healthcare HMO Rider |
$90.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.96
|
| Rate for Payer: Vantage Medical Group Senior |
$153.96
|
|
|
KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [215477]
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
CPT A9587
|
| Hospital Charge Code |
ERX215477
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Blue Shield of California Commercial |
$2,700.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,880.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Galaxy Health WC |
$3,060.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,160.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,401.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,340.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1,327.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,298.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,188.00
|
|
|
KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [215477]
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
CPT A9587
|
| Hospital Charge Code |
ERX215477
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,060.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,980.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,980.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.44
|
| Rate for Payer: Blue Distinction Transplant |
$2,160.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,224.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,880.00
|
| Rate for Payer: Cigna of CA HMO |
$2,304.00
|
| Rate for Payer: Cigna of CA PPO |
$2,664.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,060.00
|
| Rate for Payer: Dignity Health Media |
$3,060.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,440.00
|
| Rate for Payer: Galaxy Health WC |
$3,060.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,160.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,240.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,700.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,340.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,060.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,440.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,160.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,160.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,800.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,800.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,800.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,060.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,060.00
|
|
|
KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [121131]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
ERX121131
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Blue Shield of California Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.06
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.98
|
| Rate for Payer: United Healthcare All Other HMO |
$33.19
|
| Rate for Payer: United Healthcare HMO Rider |
$32.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.70
|
|
|
KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [121131]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
ERX121131
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$119.46 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.46
|
| Rate for Payer: Blue Distinction Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$55.62
|
| Rate for Payer: Blue Shield of California EPN |
$43.74
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Media |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [223025]
|
Facility
|
OP
|
$755.82
|
|
|
Service Code
|
CPT A9520
|
| Hospital Charge Code |
ERX223025
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$680.24 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$642.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.62
|
| Rate for Payer: Blue Distinction Transplant |
$453.49
|
| Rate for Payer: Blue Shield of California Commercial |
$467.10
|
| Rate for Payer: Blue Shield of California EPN |
$367.33
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Central Health Plan Commercial |
$604.66
|
| Rate for Payer: Cigna of CA HMO |
$483.72
|
| Rate for Payer: Cigna of CA PPO |
$559.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$642.45
|
| Rate for Payer: Dignity Health Media |
$642.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$642.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$302.33
|
| Rate for Payer: Galaxy Health WC |
$642.45
|
| Rate for Payer: Global Benefits Group Commercial |
$453.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$566.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$264.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$566.86
|
| Rate for Payer: Networks By Design Commercial |
$491.28
|
| Rate for Payer: Prime Health Services Commercial |
$642.45
|
| Rate for Payer: Riverside University Health System MISP |
$302.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$377.91
|
| Rate for Payer: United Healthcare All Other HMO |
$377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$377.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$642.45
|
| Rate for Payer: Vantage Medical Group Senior |
$642.45
|
|
|
KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [223025]
|
Facility
|
IP
|
$755.82
|
|
|
Service Code
|
CPT A9520
|
| Hospital Charge Code |
ERX223025
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$680.24 |
| Rate for Payer: Blue Shield of California Commercial |
$566.86
|
| Rate for Payer: Blue Shield of California EPN |
$403.61
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Central Health Plan Commercial |
$604.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.33
|
| Rate for Payer: Galaxy Health WC |
$642.45
|
| Rate for Payer: Global Benefits Group Commercial |
$453.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$566.86
|
| Rate for Payer: Networks By Design Commercial |
$491.28
|
| Rate for Payer: Prime Health Services Commercial |
$642.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.40
|
| Rate for Payer: United Healthcare All Other HMO |
$278.75
|
| Rate for Payer: United Healthcare HMO Rider |
$272.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.42
|
|
|
KIT OSTOMY SENSURA FLEX
|
Facility
|
IP
|
$13.37
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
KIT OSTOMY SENSURA FLEX
|
Facility
|
OP
|
$13.37
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.90
|
| Rate for Payer: Blue Distinction Transplant |
$8.02
|
| Rate for Payer: Blue Shield of California Commercial |
$8.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.54
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$9.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.36
|
| Rate for Payer: Dignity Health Media |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
| Rate for Payer: Riverside University Health System MISP |
$5.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.68
|
| Rate for Payer: United Healthcare HMO Rider |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.36
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$39,604.91
|
|
|
Service Code
|
APR-DRG 3133
|
| Min. Negotiated Rate |
$25,013.63 |
| Max. Negotiated Rate |
$39,604.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,013.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29,807.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,604.91
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$61,668.53
|
|
|
Service Code
|
APR-DRG 3134
|
| Min. Negotiated Rate |
$38,948.54 |
| Max. Negotiated Rate |
$61,668.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,948.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46,413.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,668.53
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$20,620.02
|
|
|
Service Code
|
APR-DRG 3131
|
| Min. Negotiated Rate |
$13,023.17 |
| Max. Negotiated Rate |
$20,620.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,023.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,519.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,620.02
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$27,146.34
|
|
|
Service Code
|
APR-DRG 3132
|
| Min. Negotiated Rate |
$17,145.06 |
| Max. Negotiated Rate |
$27,146.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,145.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,431.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,146.34
|
|
|
K-PHOS NEUTRAL ORAL SUSP CMPD 25 MG/ML (0.1 MEQ/ML) [4080284]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 9994-0802-84
|
| Hospital Charge Code |
1715213
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
K-PHOS NEUTRAL ORAL SUSP CMPD 25 MG/ML (0.1 MEQ/ML) [4080284]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 9994-0802-84
|
| Hospital Charge Code |
1715213
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 0185-0010-01
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 68001-381-00
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 60687-439-11
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Distinction Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Media |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 60687-439-01
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 60687-439-11
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 68001-381-00
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 60687-439-01
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Distinction Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Media |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
LABETALOL 100 MG TABLET [10373]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 0185-0010-01
|
| Hospital Charge Code |
1711384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
LABETALOL 200 MG TABLET [10374]
|
Facility
|
OP
|
$0.68
|
|
|
Service Code
|
NDC 68001-382-00
|
| Hospital Charge Code |
1711385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Blue Distinction Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
| Rate for Payer: Dignity Health Media |
$0.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
| Rate for Payer: Riverside University Health System MISP |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Vantage Medical Group Senior |
$0.58
|
|
