|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
|
OP
|
$7,966.49
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$7,169.84 |
| Rate for Payer: Adventist Health Commercial |
$1,593.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$43.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$254.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.51
|
| Rate for Payer: Blue Shield of California Commercial |
$51.89
|
| Rate for Payer: Blue Shield of California EPN |
$47.17
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Central Health Plan Commercial |
$6,373.19
|
| Rate for Payer: Cigna of CA HMO |
$5,576.54
|
| Rate for Payer: Cigna of CA PPO |
$5,576.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,576.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.99
|
| Rate for Payer: EPIC Health Plan Senior |
$47.99
|
| Rate for Payer: Galaxy Health WC |
$6,771.52
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,169.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,058.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,593.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$5,974.87
|
| Rate for Payer: Networks By Design Commercial |
$3,983.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43.63
|
| Rate for Payer: Prime Health Services Commercial |
$6,771.52
|
| Rate for Payer: Prime Health Services Medicare |
$46.25
|
| Rate for Payer: Riverside University Health System MISP |
$47.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,779.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,779.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,989.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2,910.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2,847.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,609.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Vantage Medical Group Senior |
$47.99
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$57,685.98
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$57,685.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,685.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37,262.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52,169.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,366.18
|
| Rate for Payer: EPIC Health Plan Senior |
$34,244.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,131.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,583.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,715.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31,131.02
|
| Rate for Payer: Prime Health Services Medicare |
$32,998.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,828.18
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$36,828.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,828.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,789.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,306.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,331.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,220.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,200.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,281.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,069.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,200.81
|
| Rate for Payer: Prime Health Services Medicare |
$21,412.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL (SEPARATE PROCEDURE);
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 60540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.17
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$24,845.03
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$15,691.60 |
| Max. Negotiated Rate |
$24,845.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,691.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,699.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,845.03
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$86,060.29
|
|
|
Service Code
|
APR-DRG 4014
|
| Min. Negotiated Rate |
$54,353.87 |
| Max. Negotiated Rate |
$86,060.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$54,353.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64,771.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86,060.29
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$45,764.41
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$28,903.84 |
| Max. Negotiated Rate |
$45,764.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,903.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,443.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,764.41
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$19,171.06
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$12,108.04 |
| Max. Negotiated Rate |
$19,171.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,108.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,428.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,171.06
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.61 |
| Max. Negotiated Rate |
$43,212.96 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$743.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,932.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,830.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,284.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,110.00
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Central Health Plan Commercial |
$38,411.52
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$817.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.96
|
| Rate for Payer: EPIC Health Plan Senior |
$817.97
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,212.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,219.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$743.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$743.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,451.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,602.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$996.44
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$743.61
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: Prime Health Services Medicare |
$788.23
|
| Rate for Payer: Riverside University Health System MISP |
$817.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,808.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,808.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$743.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Vantage Medical Group Senior |
$817.97
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,602.88 |
| Max. Negotiated Rate |
$43,212.96 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38,507.55
|
| Rate for Payer: Blue Shield of California EPN |
$24,199.26
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Central Health Plan Commercial |
$38,411.52
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.76
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.76
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,212.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,328.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,602.88
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,602.88 |
| Max. Negotiated Rate |
$43,212.96 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38,507.55
|
| Rate for Payer: Blue Shield of California EPN |
$24,199.26
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Central Health Plan Commercial |
$38,411.52
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.76
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.76
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,212.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,328.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,602.88
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.61 |
| Max. Negotiated Rate |
$43,212.96 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$743.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,932.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,830.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,284.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,110.00
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Central Health Plan Commercial |
$38,411.52
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$817.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.96
|
| Rate for Payer: EPIC Health Plan Senior |
$817.97
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,212.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,219.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$743.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$743.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,451.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,602.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$996.44
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$743.61
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: Prime Health Services Medicare |
$788.23
|
| Rate for Payer: Riverside University Health System MISP |
$817.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,808.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,808.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$743.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Vantage Medical Group Senior |
$817.97
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
OP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.68 |
| Max. Negotiated Rate |
$43,400.26 |
| Rate for Payer: Adventist Health Commercial |
$9,644.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$298.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,990.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$649.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$810.46
|
| Rate for Payer: Blue Shield of California Commercial |
$433.12
|
| Rate for Payer: Blue Shield of California EPN |
$393.75
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Central Health Plan Commercial |
$38,578.01
|
| Rate for Payer: Cigna of CA HMO |
$33,755.76
|
| Rate for Payer: Cigna of CA PPO |
$33,755.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,755.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.82
|
| Rate for Payer: EPIC Health Plan Senior |
$328.55
|
| Rate for Payer: Galaxy Health WC |
$40,989.13
|
| Rate for Payer: Global Benefits Group Commercial |
$28,933.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,400.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$489.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$298.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,621.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,644.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$400.23
|
| Rate for Payer: Multiplan Commercial |
$36,166.88
|
| Rate for Payer: Networks By Design Commercial |
$24,111.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$298.68
|
| Rate for Payer: Prime Health Services Commercial |
$40,989.13
|
| Rate for Payer: Prime Health Services Medicare |
$316.60
|
| Rate for Payer: Riverside University Health System MISP |
$328.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,933.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,933.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,097.91
|
| Rate for Payer: United Healthcare All Other HMO |
$17,615.68
|
| Rate for Payer: United Healthcare HMO Rider |
$17,234.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,792.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$298.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$328.55
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
IP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,644.50 |
| Max. Negotiated Rate |
$43,400.26 |
| Rate for Payer: Adventist Health Commercial |
$9,644.50
|
| Rate for Payer: Blue Shield of California Commercial |
$38,674.45
|
| Rate for Payer: Blue Shield of California EPN |
$24,304.15
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Central Health Plan Commercial |
$38,578.01
|
| Rate for Payer: Cigna of CA HMO |
$33,755.76
|
| Rate for Payer: Cigna of CA PPO |
$33,755.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,755.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,289.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,289.00
|
| Rate for Payer: Galaxy Health WC |
$40,989.13
|
| Rate for Payer: Global Benefits Group Commercial |
$28,933.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,400.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,621.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,451.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,644.50
|
| Rate for Payer: Multiplan Commercial |
$36,166.88
|
| Rate for Payer: Networks By Design Commercial |
$24,111.26
|
| Rate for Payer: Prime Health Services Commercial |
$40,989.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,097.91
|
| Rate for Payer: United Healthcare All Other HMO |
$17,615.68
|
| Rate for Payer: United Healthcare HMO Rider |
$17,234.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,792.87
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$29,637.83
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$29,637.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,637.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,144.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,803.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,114.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18,076.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,432.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,005.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,019.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,432.83
|
| Rate for Payer: Prime Health Services Medicare |
$17,418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$49,082.30
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$49,082.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,082.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31,705.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44,388.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,926.94
|
| Rate for Payer: EPIC Health Plan Senior |
$29,284.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,622.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,271.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,674.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26,622.39
|
| Rate for Payer: Prime Health Services Medicare |
$28,219.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,157.84
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,157.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,157.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,667.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,134.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,781.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13,187.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,989.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,784.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,065.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,989.02
|
| Rate for Payer: Prime Health Services Medicare |
$12,708.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$31,311.71
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$31,311.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,311.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,226.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,317.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,561.48
|
| Rate for Payer: EPIC Health Plan Senior |
$19,040.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,309.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,233.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,195.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,309.99
|
| Rate for Payer: Prime Health Services Medicare |
$18,348.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$16,520.44
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$16,520.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,520.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,671.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,940.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,772.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10,514.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,558.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,382.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,808.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,558.87
|
| Rate for Payer: Prime Health Services Medicare |
$10,132.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
IP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,934.95 |
| Max. Negotiated Rate |
$8,707.27 |
| Rate for Payer: Adventist Health Commercial |
$1,934.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,759.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,876.07
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Central Health Plan Commercial |
$7,739.80
|
| Rate for Payer: Cigna of CA HMO |
$6,772.32
|
| Rate for Payer: Cigna of CA PPO |
$6,772.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,772.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,869.90
|
| Rate for Payer: EPIC Health Plan Senior |
$3,869.90
|
| Rate for Payer: Galaxy Health WC |
$8,223.54
|
| Rate for Payer: Global Benefits Group Commercial |
$5,804.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,707.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,143.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,708.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.95
|
| Rate for Payer: Multiplan Commercial |
$7,256.06
|
| Rate for Payer: Networks By Design Commercial |
$4,837.38
|
| Rate for Payer: Prime Health Services Commercial |
$8,223.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,630.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3,534.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,168.48
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
OP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.72 |
| Max. Negotiated Rate |
$8,707.27 |
| Rate for Payer: Adventist Health Commercial |
$1,934.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$232.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,380.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.90
|
| Rate for Payer: Blue Shield of California Commercial |
$281.11
|
| Rate for Payer: Blue Shield of California EPN |
$255.55
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Central Health Plan Commercial |
$7,739.80
|
| Rate for Payer: Cigna of CA HMO |
$6,772.32
|
| Rate for Payer: Cigna of CA PPO |
$6,772.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,772.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.99
|
| Rate for Payer: EPIC Health Plan Senior |
$255.99
|
| Rate for Payer: Galaxy Health WC |
$8,223.54
|
| Rate for Payer: Global Benefits Group Commercial |
$5,804.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,707.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$381.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,143.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$437.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$7,256.06
|
| Rate for Payer: Networks By Design Commercial |
$4,837.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$232.72
|
| Rate for Payer: Prime Health Services Commercial |
$8,223.54
|
| Rate for Payer: Prime Health Services Medicare |
$246.68
|
| Rate for Payer: Riverside University Health System MISP |
$255.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,804.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,804.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,630.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3,534.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,168.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$232.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Vantage Medical Group Senior |
$255.99
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
OP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.72 |
| Max. Negotiated Rate |
$1,380.96 |
| Rate for Payer: Adventist Health Commercial |
$276.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$232.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,380.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.90
|
| Rate for Payer: Blue Shield of California Commercial |
$281.11
|
| Rate for Payer: Blue Shield of California EPN |
$255.55
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Central Health Plan Commercial |
$1,105.50
|
| Rate for Payer: Cigna of CA HMO |
$967.31
|
| Rate for Payer: Cigna of CA PPO |
$967.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$967.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.99
|
| Rate for Payer: EPIC Health Plan Senior |
$255.99
|
| Rate for Payer: Galaxy Health WC |
$1,174.59
|
| Rate for Payer: Global Benefits Group Commercial |
$829.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,243.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$381.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$877.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$437.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$1,036.40
|
| Rate for Payer: Networks By Design Commercial |
$690.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$232.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.59
|
| Rate for Payer: Prime Health Services Medicare |
$246.68
|
| Rate for Payer: Riverside University Health System MISP |
$255.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$829.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.62
|
| Rate for Payer: United Healthcare All Other HMO |
$504.80
|
| Rate for Payer: United Healthcare HMO Rider |
$493.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$232.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Vantage Medical Group Senior |
$255.99
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
IP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.37 |
| Max. Negotiated Rate |
$1,243.68 |
| Rate for Payer: Adventist Health Commercial |
$276.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,108.26
|
| Rate for Payer: Blue Shield of California EPN |
$696.46
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Central Health Plan Commercial |
$1,105.50
|
| Rate for Payer: Cigna of CA HMO |
$967.31
|
| Rate for Payer: Cigna of CA PPO |
$967.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$967.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.75
|
| Rate for Payer: EPIC Health Plan Senior |
$552.75
|
| Rate for Payer: Galaxy Health WC |
$1,174.59
|
| Rate for Payer: Global Benefits Group Commercial |
$829.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,243.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$877.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$815.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.37
|
| Rate for Payer: Multiplan Commercial |
$1,036.40
|
| Rate for Payer: Networks By Design Commercial |
$690.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.62
|
| Rate for Payer: United Healthcare All Other HMO |
$504.80
|
| Rate for Payer: United Healthcare HMO Rider |
$493.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.56
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
