|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.47
|
| Rate for Payer: Blue Shield of California Commercial |
$49.39
|
| Rate for Payer: Blue Shield of California EPN |
$32.25
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Central Health Plan Commercial |
$64.66
|
| Rate for Payer: Cigna of CA HMO |
$51.73
|
| Rate for Payer: Cigna of CA PPO |
$59.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.75
|
| Rate for Payer: InnovAge PACE Commercial |
$40.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: Networks By Design Commercial |
$52.54
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: Riverside University Health System MISP |
$32.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.41
|
| Rate for Payer: United Healthcare All Other HMO |
$40.41
|
| Rate for Payer: United Healthcare HMO Rider |
$40.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$89.82
|
| Rate for Payer: Blue Shield of California EPN |
$58.65
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$94.08
|
| Rate for Payer: Cigna of CA PPO |
$108.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: InnovAge PACE Commercial |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.50
|
| Rate for Payer: United Healthcare HMO Rider |
$73.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$145.49 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Blue Shield of California Commercial |
$124.96
|
| Rate for Payer: Blue Shield of California EPN |
$81.48
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Central Health Plan Commercial |
$129.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.33
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Networks By Design Commercial |
$105.08
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$145.49 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.94
|
| Rate for Payer: Blue Shield of California Commercial |
$98.77
|
| Rate for Payer: Blue Shield of California EPN |
$64.50
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Central Health Plan Commercial |
$129.33
|
| Rate for Payer: Cigna of CA HMO |
$103.46
|
| Rate for Payer: Cigna of CA PPO |
$119.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.49
|
| Rate for Payer: InnovAge PACE Commercial |
$80.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Networks By Design Commercial |
$105.08
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
| Rate for Payer: Riverside University Health System MISP |
$64.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.83
|
| Rate for Payer: United Healthcare All Other HMO |
$80.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-05
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$138.91 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.64
|
| Rate for Payer: Blue Shield of California Commercial |
$94.30
|
| Rate for Payer: Blue Shield of California EPN |
$61.58
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Central Health Plan Commercial |
$123.47
|
| Rate for Payer: Cigna of CA HMO |
$98.78
|
| Rate for Payer: Cigna of CA PPO |
$114.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.91
|
| Rate for Payer: InnovAge PACE Commercial |
$77.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.04
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Networks By Design Commercial |
$100.32
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
| Rate for Payer: Riverside University Health System MISP |
$61.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.17
|
| Rate for Payer: United Healthcare All Other HMO |
$77.17
|
| Rate for Payer: United Healthcare HMO Rider |
$77.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-05
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$138.91 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$119.30
|
| Rate for Payer: Blue Shield of California EPN |
$77.79
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Central Health Plan Commercial |
$123.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Networks By Design Commercial |
$100.32
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$138.91 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.64
|
| Rate for Payer: Blue Shield of California Commercial |
$94.30
|
| Rate for Payer: Blue Shield of California EPN |
$61.58
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Central Health Plan Commercial |
$123.47
|
| Rate for Payer: Cigna of CA HMO |
$98.78
|
| Rate for Payer: Cigna of CA PPO |
$114.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.91
|
| Rate for Payer: InnovAge PACE Commercial |
$77.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.04
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Networks By Design Commercial |
$100.32
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
| Rate for Payer: Riverside University Health System MISP |
$61.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.17
|
| Rate for Payer: United Healthcare All Other HMO |
$77.17
|
| Rate for Payer: United Healthcare HMO Rider |
$77.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-02
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$145.49 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.94
|
| Rate for Payer: Blue Shield of California Commercial |
$98.77
|
| Rate for Payer: Blue Shield of California EPN |
$64.50
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Central Health Plan Commercial |
$129.33
|
| Rate for Payer: Cigna of CA HMO |
$103.46
|
| Rate for Payer: Cigna of CA PPO |
$119.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.49
|
| Rate for Payer: InnovAge PACE Commercial |
$80.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Networks By Design Commercial |
$105.08
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
| Rate for Payer: Riverside University Health System MISP |
$64.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.83
|
| Rate for Payer: United Healthcare All Other HMO |
$80.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-02
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$145.49 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Blue Shield of California Commercial |
$124.96
|
| Rate for Payer: Blue Shield of California EPN |
$81.48
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Central Health Plan Commercial |
$129.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.33
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Networks By Design Commercial |
$105.08
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$89.82
|
| Rate for Payer: Blue Shield of California EPN |
$58.65
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$94.08
|
| Rate for Payer: Cigna of CA PPO |
$108.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: InnovAge PACE Commercial |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.50
|
| Rate for Payer: United Healthcare HMO Rider |
$73.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$138.91 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$119.30
|
| Rate for Payer: Blue Shield of California EPN |
$77.79
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Central Health Plan Commercial |
$123.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Networks By Design Commercial |
$100.32
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.22
|
| Rate for Payer: InnovAge PACE Commercial |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
OP
|
$884.58
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$796.12 |
| Rate for Payer: Adventist Health Commercial |
$176.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$537.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$38.16
|
| Rate for Payer: Blue Shield of California EPN |
$34.69
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Central Health Plan Commercial |
$707.66
|
| Rate for Payer: Cigna of CA HMO |
$619.21
|
| Rate for Payer: Cigna of CA PPO |
$619.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.48
|
| Rate for Payer: EPIC Health Plan Senior |
$29.98
|
| Rate for Payer: Galaxy Health WC |
$751.89
|
| Rate for Payer: Global Benefits Group Commercial |
$530.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$796.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$49.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.98
|
| Rate for Payer: InnovAge PACE Commercial |
$44.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.18
|
| Rate for Payer: Multiplan Commercial |
$663.43
|
| Rate for Payer: Networks By Design Commercial |
$442.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.98
|
| Rate for Payer: Prime Health Services Commercial |
$751.89
|
| Rate for Payer: Prime Health Services Medicare |
$31.78
|
| Rate for Payer: Riverside University Health System MISP |
$32.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$530.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$530.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.98
|
| Rate for Payer: United Healthcare All Other HMO |
$323.14
|
| Rate for Payer: United Healthcare HMO Rider |
$316.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$289.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.98
|
| Rate for Payer: Vantage Medical Group Senior |
$32.98
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
IP
|
$884.58
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.92 |
| Max. Negotiated Rate |
$796.12 |
| Rate for Payer: Adventist Health Commercial |
$176.92
|
| Rate for Payer: Blue Shield of California Commercial |
$683.78
|
| Rate for Payer: Blue Shield of California EPN |
$445.83
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Central Health Plan Commercial |
$707.66
|
| Rate for Payer: Cigna of CA HMO |
$619.21
|
| Rate for Payer: Cigna of CA PPO |
$619.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.83
|
| Rate for Payer: EPIC Health Plan Senior |
$353.83
|
| Rate for Payer: Galaxy Health WC |
$751.89
|
| Rate for Payer: Global Benefits Group Commercial |
$530.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$796.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$547.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.92
|
| Rate for Payer: Multiplan Commercial |
$663.43
|
| Rate for Payer: Networks By Design Commercial |
$442.29
|
| Rate for Payer: Prime Health Services Commercial |
$751.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.98
|
| Rate for Payer: United Healthcare All Other HMO |
$323.14
|
| Rate for Payer: United Healthcare HMO Rider |
$316.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$289.70
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
|
OP
|
$102.09
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Adventist Health Commercial |
$20.42
|
| Rate for Payer: Adventist Health Commercial |
$18.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.21
|
| Rate for Payer: Blue Shield of California Commercial |
$13.21
|
| Rate for Payer: Blue Shield of California EPN |
$12.01
|
| Rate for Payer: Blue Shield of California EPN |
$12.01
|
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Central Health Plan Commercial |
$81.67
|
| Rate for Payer: Central Health Plan Commercial |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$64.97
|
| Rate for Payer: Cigna of CA HMO |
$71.46
|
| Rate for Payer: Cigna of CA PPO |
$64.97
|
| Rate for Payer: Cigna of CA PPO |
$71.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.84
|
| Rate for Payer: EPIC Health Plan Senior |
$40.84
|
| Rate for Payer: EPIC Health Plan Senior |
$37.12
|
| Rate for Payer: Galaxy Health WC |
$78.89
|
| Rate for Payer: Galaxy Health WC |
$86.78
|
| Rate for Payer: Global Benefits Group Commercial |
$55.69
|
| Rate for Payer: Global Benefits Group Commercial |
$61.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.88
|
| Rate for Payer: InnovAge PACE Commercial |
$51.05
|
| Rate for Payer: InnovAge PACE Commercial |
$46.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.46
|
| Rate for Payer: Multiplan Commercial |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$69.61
|
| Rate for Payer: Networks By Design Commercial |
$46.41
|
| Rate for Payer: Networks By Design Commercial |
$51.05
|
| Rate for Payer: Prime Health Services Commercial |
$78.89
|
| Rate for Payer: Prime Health Services Commercial |
$86.78
|
| Rate for Payer: Riverside University Health System MISP |
$40.84
|
| Rate for Payer: Riverside University Health System MISP |
$37.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.31
|
| Rate for Payer: United Healthcare All Other HMO |
$37.29
|
| Rate for Payer: United Healthcare All Other HMO |
$33.90
|
| Rate for Payer: United Healthcare HMO Rider |
$36.49
|
| Rate for Payer: United Healthcare HMO Rider |
$33.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.89
|
| Rate for Payer: Vantage Medical Group Senior |
$86.78
|
| Rate for Payer: Vantage Medical Group Senior |
$78.89
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
|
IP
|
$92.81
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$83.53 |
| Rate for Payer: Adventist Health Commercial |
$18.56
|
| Rate for Payer: Adventist Health Commercial |
$20.42
|
| Rate for Payer: Blue Shield of California Commercial |
$71.74
|
| Rate for Payer: Blue Shield of California Commercial |
$78.92
|
| Rate for Payer: Blue Shield of California EPN |
$51.45
|
| Rate for Payer: Blue Shield of California EPN |
$46.78
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Central Health Plan Commercial |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$81.67
|
| Rate for Payer: Cigna of CA HMO |
$71.46
|
| Rate for Payer: Cigna of CA HMO |
$64.97
|
| Rate for Payer: Cigna of CA PPO |
$71.46
|
| Rate for Payer: Cigna of CA PPO |
$64.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.12
|
| Rate for Payer: EPIC Health Plan Senior |
$40.84
|
| Rate for Payer: EPIC Health Plan Senior |
$37.12
|
| Rate for Payer: Galaxy Health WC |
$86.78
|
| Rate for Payer: Galaxy Health WC |
$78.89
|
| Rate for Payer: Global Benefits Group Commercial |
$55.69
|
| Rate for Payer: Global Benefits Group Commercial |
$61.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$69.61
|
| Rate for Payer: Networks By Design Commercial |
$51.05
|
| Rate for Payer: Networks By Design Commercial |
$46.41
|
| Rate for Payer: Prime Health Services Commercial |
$78.89
|
| Rate for Payer: Prime Health Services Commercial |
$86.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.83
|
| Rate for Payer: United Healthcare All Other HMO |
$33.90
|
| Rate for Payer: United Healthcare All Other HMO |
$37.29
|
| Rate for Payer: United Healthcare HMO Rider |
$36.49
|
| Rate for Payer: United Healthcare HMO Rider |
$33.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.40
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]
|
Facility
|
OP
|
$508.62
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.77 |
| Max. Negotiated Rate |
$457.76 |
| Rate for Payer: Adventist Health Commercial |
$101.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$47.51
|
| Rate for Payer: Blue Shield of California EPN |
$43.19
|
| Rate for Payer: Cash Price |
$279.74
|
| Rate for Payer: Cash Price |
$279.74
|
| Rate for Payer: Central Health Plan Commercial |
$406.90
|
| Rate for Payer: Cigna of CA HMO |
$356.03
|
| Rate for Payer: Cigna of CA PPO |
$356.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.54
|
| Rate for Payer: EPIC Health Plan Senior |
$30.77
|
| Rate for Payer: Galaxy Health WC |
$432.33
|
| Rate for Payer: Global Benefits Group Commercial |
$305.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$457.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.77
|
| Rate for Payer: InnovAge PACE Commercial |
$46.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.23
|
| Rate for Payer: Multiplan Commercial |
$381.46
|
| Rate for Payer: Networks By Design Commercial |
$254.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.77
|
| Rate for Payer: Prime Health Services Commercial |
$432.33
|
| Rate for Payer: Prime Health Services Medicare |
$32.62
|
| Rate for Payer: Riverside University Health System MISP |
$33.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$190.89
|
| Rate for Payer: United Healthcare All Other HMO |
$185.80
|
| Rate for Payer: United Healthcare HMO Rider |
$181.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.85
|
| Rate for Payer: Vantage Medical Group Senior |
$33.85
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]
|
Facility
|
IP
|
$508.62
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$457.76 |
| Rate for Payer: Adventist Health Commercial |
$101.72
|
| Rate for Payer: Blue Shield of California Commercial |
$393.16
|
| Rate for Payer: Blue Shield of California EPN |
$256.34
|
| Rate for Payer: Cash Price |
$279.74
|
| Rate for Payer: Central Health Plan Commercial |
$406.90
|
| Rate for Payer: Cigna of CA HMO |
$356.03
|
| Rate for Payer: Cigna of CA PPO |
$356.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.45
|
| Rate for Payer: EPIC Health Plan Senior |
$203.45
|
| Rate for Payer: Galaxy Health WC |
$432.33
|
| Rate for Payer: Global Benefits Group Commercial |
$305.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$457.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.72
|
| Rate for Payer: Multiplan Commercial |
$381.46
|
| Rate for Payer: Networks By Design Commercial |
$254.31
|
| Rate for Payer: Prime Health Services Commercial |
$432.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$190.89
|
| Rate for Payer: United Healthcare All Other HMO |
$185.80
|
| Rate for Payer: United Healthcare HMO Rider |
$181.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.57
|
|
|
RIBAVIRIN 200 MG TABLET [11287]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 65862-207-68
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
RIBAVIRIN 200 MG TABLET [11287]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 65862-207-68
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: InnovAge PACE Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Riverside University Health System MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 1184571401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0761003220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
