|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 6068771511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 6068771521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 0115521218
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 0115521218
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Riverside University Health System MISP |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$26.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]
|
Facility
|
OP
|
$33.59
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$117.34 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.51
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
|
OP
|
$33.59
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$117.34 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.51
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$26.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$26.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
|
OP
|
$33.59
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$117.34 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.51
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$10.45
|
|
|
Service Code
|
NDC 9999999682
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$8.38
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Central Health Plan Commercial |
$8.36
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.88
|
| Rate for Payer: Global Benefits Group Commercial |
$6.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.88
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$13.33
|
|
|
Service Code
|
NDC 5048401030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.45
|
| Rate for Payer: Blue Shield of California EPN |
$5.32
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.66
|
| Rate for Payer: Cigna of CA HMO |
$9.33
|
| Rate for Payer: Cigna of CA PPO |
$9.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Senior |
$5.33
|
| Rate for Payer: Galaxy Health WC |
$11.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.33
|
| Rate for Payer: Multiplan Commercial |
$10.00
|
| Rate for Payer: Networks By Design Commercial |
$8.66
|
| Rate for Payer: Prime Health Services Commercial |
$11.33
|
| Rate for Payer: Riverside University Health System MISP |
$5.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.67
|
| Rate for Payer: United Healthcare All Other HMO |
$6.67
|
| Rate for Payer: United Healthcare HMO Rider |
$6.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.33
|
| Rate for Payer: Vantage Medical Group Senior |
$11.33
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$10.45
|
|
|
Service Code
|
NDC 9999999682
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6.63
|
| Rate for Payer: Blue Shield of California EPN |
$4.17
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Central Health Plan Commercial |
$8.36
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.88
|
| Rate for Payer: Global Benefits Group Commercial |
$6.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.88
|
| Rate for Payer: Riverside University Health System MISP |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.22
|
| Rate for Payer: United Healthcare HMO Rider |
$5.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.88
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$13.33
|
|
|
Service Code
|
NDC 5048401030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Blue Shield of California Commercial |
$10.69
|
| Rate for Payer: Blue Shield of California EPN |
$6.72
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.66
|
| Rate for Payer: Cigna of CA HMO |
$9.33
|
| Rate for Payer: Cigna of CA PPO |
$9.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Senior |
$5.33
|
| Rate for Payer: Galaxy Health WC |
$11.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.00
|
| Rate for Payer: Networks By Design Commercial |
$8.66
|
| Rate for Payer: Prime Health Services Commercial |
$11.33
|
|
|
COLLOIDAL OATMEAL TOPICAL PACKET [81870]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 8137003640
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
COLLOIDAL OATMEAL TOPICAL PACKET [81870]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 8137003640
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Riverside University Health System MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,196.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,196.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Prime Health Services Medicare |
$1,267.84
|
| Rate for Payer: Riverside University Health System MISP |
$1,315.69
|
| 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
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
COLPOCLEISIS (LE FORT TYPE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.83 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,433.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,433.99
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$9,993.72
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,077.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,433.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7,077.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,551.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,045.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,155.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,007.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,621.55
|
| Rate for Payer: Multiplan WC |
$9,993.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Preferred Health Network WC |
$10,197.67
|
| Rate for Payer: Prime Health Services Medicare |
$6,820.03
|
| Rate for Payer: Prime Health Services WC |
$9,891.74
|
| Rate for Payer: Riverside University Health System MISP |
$7,077.39
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,433.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Vantage Medical Group Senior |
$6,433.99
|
|
|
COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,065.66 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,537.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,491.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,537.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,970.61
|
| 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: Dignity Health Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,491.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,537.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,736.86
|
| Rate for Payer: EPIC Health Plan Senior |
$10,491.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,641.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,065.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,537.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,177.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,352.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,780.24
|
| Rate for Payer: Multiplan WC |
$14,970.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,537.49
|
| Rate for Payer: Preferred Health Network WC |
$15,276.13
|
| Rate for Payer: Prime Health Services Medicare |
$10,109.74
|
| Rate for Payer: Prime Health Services WC |
$14,817.85
|
| Rate for Payer: Riverside University Health System MISP |
$10,491.24
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,537.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,491.24
|
| Rate for Payer: Vantage Medical Group Senior |
$9,537.49
|
|
|
COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.63 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,537.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,491.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,537.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,970.61
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,491.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,537.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,736.86
|
| Rate for Payer: EPIC Health Plan Senior |
$10,491.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,641.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$626.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,537.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$692.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,352.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,780.24
|
| Rate for Payer: Multiplan WC |
$14,970.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,537.49
|
| Rate for Payer: Preferred Health Network WC |
$15,276.13
|
| Rate for Payer: Prime Health Services Medicare |
$10,109.74
|
| Rate for Payer: Prime Health Services WC |
$14,817.85
|
| Rate for Payer: Riverside University Health System MISP |
$10,491.24
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,537.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,306.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,491.24
|
| Rate for Payer: Vantage Medical Group Senior |
$9,537.49
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$391.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| 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: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$237,123.66
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$125,162.43 |
| Max. Negotiated Rate |
$237,123.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$237,123.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153,172.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214,446.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$206,518.01
|
| Rate for Payer: EPIC Health Plan Senior |
$137,678.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125,162.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175,227.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$167,717.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$125,162.43
|
| Rate for Payer: Prime Health Services Medicare |
$132,672.18
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$151,784.30
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$80,441.72 |
| Max. Negotiated Rate |
$151,784.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$151,784.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98,046.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137,268.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$132,728.84
|
| Rate for Payer: EPIC Health Plan Senior |
$88,485.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80,441.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112,618.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$107,791.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80,441.72
|
| Rate for Payer: Prime Health Services Medicare |
$85,268.22
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.99 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,433.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,433.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$9,993.72
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,077.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,433.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7,077.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,551.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,192.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,317.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,007.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,621.55
|
| Rate for Payer: Multiplan WC |
$9,993.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Preferred Health Network WC |
$10,197.67
|
| Rate for Payer: Prime Health Services Medicare |
$6,820.03
|
| Rate for Payer: Prime Health Services WC |
$9,891.74
|
| Rate for Payer: Riverside University Health System MISP |
$7,077.39
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,433.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Vantage Medical Group Senior |
$6,433.99
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,220.13 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Multiplan WC |
$9,993.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,433.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,433.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$9,993.72
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,077.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,433.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7,077.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,551.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,220.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,347.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,007.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,621.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Preferred Health Network WC |
$10,197.67
|
| Rate for Payer: Prime Health Services Medicare |
$6,820.03
|
| Rate for Payer: Prime Health Services WC |
$9,891.74
|
| Rate for Payer: Riverside University Health System MISP |
$7,077.39
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,433.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Vantage Medical Group Senior |
$6,433.99
|
|
