|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
IP
|
$832.93
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.59 |
| Max. Negotiated Rate |
$749.64 |
| Rate for Payer: Adventist Health Commercial |
$166.59
|
| Rate for Payer: Blue Shield of California Commercial |
$668.01
|
| Rate for Payer: Blue Shield of California EPN |
$419.80
|
| Rate for Payer: Cash Price |
$374.82
|
| Rate for Payer: Central Health Plan Commercial |
$666.34
|
| Rate for Payer: Cigna of CA HMO |
$583.05
|
| Rate for Payer: Cigna of CA PPO |
$583.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.17
|
| Rate for Payer: EPIC Health Plan Senior |
$333.17
|
| Rate for Payer: Galaxy Health WC |
$707.99
|
| Rate for Payer: Global Benefits Group Commercial |
$499.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.59
|
| Rate for Payer: Multiplan Commercial |
$624.70
|
| Rate for Payer: Networks By Design Commercial |
$416.46
|
| Rate for Payer: Prime Health Services Commercial |
$707.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.60
|
| Rate for Payer: United Healthcare All Other HMO |
$304.27
|
| Rate for Payer: United Healthcare HMO Rider |
$297.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.78
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
OP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$1,949.13 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$331.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,949.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.19
|
| Rate for Payer: Blue Shield of California Commercial |
$546.36
|
| Rate for Payer: Blue Shield of California EPN |
$496.69
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Central Health Plan Commercial |
$416.46
|
| Rate for Payer: Cigna of CA HMO |
$364.40
|
| Rate for Payer: Cigna of CA PPO |
$364.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.77
|
| Rate for Payer: EPIC Health Plan Senior |
$365.18
|
| Rate for Payer: Galaxy Health WC |
$442.48
|
| Rate for Payer: Global Benefits Group Commercial |
$312.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$544.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$444.85
|
| Rate for Payer: Multiplan Commercial |
$390.43
|
| Rate for Payer: Networks By Design Commercial |
$260.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$331.98
|
| Rate for Payer: Prime Health Services Commercial |
$442.48
|
| Rate for Payer: Prime Health Services Medicare |
$351.90
|
| Rate for Payer: Riverside University Health System MISP |
$365.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.37
|
| Rate for Payer: United Healthcare All Other HMO |
$190.16
|
| Rate for Payer: United Healthcare HMO Rider |
$186.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$331.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Vantage Medical Group Senior |
$365.18
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
IP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Blue Shield of California Commercial |
$417.50
|
| Rate for Payer: Blue Shield of California EPN |
$262.37
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Central Health Plan Commercial |
$416.46
|
| Rate for Payer: Cigna of CA HMO |
$364.40
|
| Rate for Payer: Cigna of CA PPO |
$364.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.23
|
| Rate for Payer: EPIC Health Plan Senior |
$208.23
|
| Rate for Payer: Galaxy Health WC |
$442.48
|
| Rate for Payer: Global Benefits Group Commercial |
$312.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.11
|
| Rate for Payer: Multiplan Commercial |
$390.43
|
| Rate for Payer: Networks By Design Commercial |
$260.29
|
| Rate for Payer: Prime Health Services Commercial |
$442.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.37
|
| Rate for Payer: United Healthcare All Other HMO |
$190.16
|
| Rate for Payer: United Healthcare HMO Rider |
$186.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.49
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
OP
|
$542.39
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$1,949.13 |
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$331.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,949.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.19
|
| Rate for Payer: Blue Shield of California Commercial |
$546.36
|
| Rate for Payer: Blue Shield of California EPN |
$496.69
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Central Health Plan Commercial |
$433.91
|
| Rate for Payer: Cigna of CA HMO |
$379.67
|
| Rate for Payer: Cigna of CA PPO |
$379.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.77
|
| Rate for Payer: EPIC Health Plan Senior |
$365.18
|
| Rate for Payer: Galaxy Health WC |
$461.03
|
| Rate for Payer: Global Benefits Group Commercial |
$325.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$488.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$544.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$444.85
|
| Rate for Payer: Multiplan Commercial |
$406.79
|
| Rate for Payer: Networks By Design Commercial |
$271.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$331.98
|
| Rate for Payer: Prime Health Services Commercial |
$461.03
|
| Rate for Payer: Prime Health Services Medicare |
$351.90
|
| Rate for Payer: Riverside University Health System MISP |
$365.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other HMO |
$198.14
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$331.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Vantage Medical Group Senior |
$365.18
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$542.39
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$273.36
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Central Health Plan Commercial |
$433.91
|
| Rate for Payer: Cigna of CA HMO |
$379.67
|
| Rate for Payer: Cigna of CA PPO |
$379.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.96
|
| Rate for Payer: EPIC Health Plan Senior |
$216.96
|
| Rate for Payer: Galaxy Health WC |
$461.03
|
| Rate for Payer: Global Benefits Group Commercial |
$325.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$488.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$320.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$406.79
|
| Rate for Payer: Networks By Design Commercial |
$271.19
|
| Rate for Payer: Prime Health Services Commercial |
$461.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other HMO |
$198.14
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.63
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487590199
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487590199
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 27059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,559.50 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,735.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,794.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,559.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,827.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Medicare |
$3,960.11
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF THIGH OR KNEE AREA; 5 CM OR GREATER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 27364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$441.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,735.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,794.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Medicare |
$3,960.11
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM OR GREATER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 24079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,808.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,735.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,794.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,808.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,997.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Medicare |
$3,960.11
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
IP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$107.89 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California Commercial |
$96.14
|
| Rate for Payer: Blue Shield of California EPN |
$60.42
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Central Health Plan Commercial |
$95.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.98
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
OP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$107.89 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.91
|
| Rate for Payer: Blue Shield of California Commercial |
$76.00
|
| Rate for Payer: Blue Shield of California EPN |
$47.83
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Central Health Plan Commercial |
$95.90
|
| Rate for Payer: Cigna of CA HMO |
$76.72
|
| Rate for Payer: Cigna of CA PPO |
$88.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.92
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
| Rate for Payer: Riverside University Health System MISP |
$47.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.94
|
| Rate for Payer: United Healthcare All Other HMO |
$59.94
|
| Rate for Payer: United Healthcare HMO Rider |
$59.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.90
|
| Rate for Payer: Vantage Medical Group Senior |
$101.90
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$71,311.33
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$71,311.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71,311.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,064.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64,491.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$63,147.41
|
| Rate for Payer: EPIC Health Plan Senior |
$42,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,271.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53,579.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51,283.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38,271.16
|
| Rate for Payer: Prime Health Services Medicare |
$40,567.43
|
| 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
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$45,498.54
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$28,735.92 |
| Max. Negotiated Rate |
$45,498.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,735.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,243.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,498.54
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$21,866.06
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$13,810.14 |
| Max. Negotiated Rate |
$21,866.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,810.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,457.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,866.06
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$10,767.85
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$6,800.75 |
| Max. Negotiated Rate |
$10,767.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,800.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,104.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,767.85
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$35,602.83
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$22,486.00 |
| Max. Negotiated Rate |
$35,602.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,486.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,795.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,602.83
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
IP
|
$60,372.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12,074.40 |
| Max. Negotiated Rate |
$54,334.80 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Blue Shield of California Commercial |
$48,418.34
|
| Rate for Payer: Blue Shield of California EPN |
$30,427.49
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Central Health Plan Commercial |
$48,297.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,260.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,148.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24,148.80
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$54,334.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,336.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,619.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,074.40
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,657.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22,053.89
|
| Rate for Payer: United Healthcare HMO Rider |
$21,576.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,771.83
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
OP
|
$60,372.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$181.55 |
| Max. Negotiated Rate |
$54,334.80 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$181.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$225.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.12
|
| Rate for Payer: Blue Shield of California Commercial |
$38,034.36
|
| Rate for Payer: Blue Shield of California EPN |
$23,967.68
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Central Health Plan Commercial |
$48,297.60
|
| Rate for Payer: Cigna of CA HMO |
$38,638.08
|
| Rate for Payer: Cigna of CA PPO |
$44,675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,260.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.56
|
| Rate for Payer: EPIC Health Plan Senior |
$199.71
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$54,334.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$181.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,336.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,074.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$243.28
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$181.55
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: Prime Health Services Medicare |
$192.44
|
| Rate for Payer: Riverside University Health System MISP |
$199.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,223.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,657.61
|
| Rate for Payer: United Healthcare All Other HMO |
$22,053.89
|
| Rate for Payer: United Healthcare HMO Rider |
$21,576.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,771.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$181.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Vantage Medical Group Senior |
$199.71
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5026869411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5026869415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$1.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5026869411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$1.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 4359850530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Riverside University Health System MISP |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 4359850530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5026869415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
