|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
IP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$734.94 |
| Rate for Payer: Blue Shield of California Commercial |
$612.45
|
| Rate for Payer: Blue Shield of California EPN |
$436.06
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Central Health Plan Commercial |
$653.28
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$326.64
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$734.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.32
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
OP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$1,992.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$324.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,992.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.03
|
| Rate for Payer: BCBS Transplant Transplant |
$291.72
|
| Rate for Payer: Blue Shield of California Commercial |
$458.18
|
| Rate for Payer: Blue Shield of California EPN |
$416.53
|
| Rate for Payer: Caremore Medicare Advantage |
$324.74
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Central Health Plan Commercial |
$388.96
|
| Rate for Payer: Cigna of CA HMO |
$340.34
|
| Rate for Payer: Cigna of CA PPO |
$340.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$324.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.74
|
| Rate for Payer: Galaxy Health WC |
$413.27
|
| Rate for Payer: Global Benefits Group Commercial |
$291.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$364.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$532.58
|
| Rate for Payer: IEHP medi-cal |
$535.83
|
| Rate for Payer: IEHP Medicare Advantage |
$324.74
|
| Rate for Payer: Innovage PACE Commercial |
$487.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.16
|
| Rate for Payer: Multiplan Commercial |
$364.65
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$413.27
|
| Rate for Payer: Prime Health Services Medicare |
$344.23
|
| Rate for Payer: Riverside University Health MISP |
$357.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.10
|
| Rate for Payer: United Healthcare All Other HMO |
$243.10
|
| Rate for Payer: United Healthcare HMO Rider |
$243.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
IP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$437.58 |
| Rate for Payer: Blue Shield of California Commercial |
$364.65
|
| Rate for Payer: Blue Shield of California EPN |
$259.63
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Central Health Plan Commercial |
$388.96
|
| Rate for Payer: Cigna of CA HMO |
$340.34
|
| Rate for Payer: Cigna of CA PPO |
$340.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.48
|
| Rate for Payer: Galaxy Health WC |
$413.27
|
| Rate for Payer: Global Benefits Group Commercial |
$291.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.24
|
| Rate for Payer: Multiplan Commercial |
$364.65
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$413.27
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
OP
|
$477.59
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
1720343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$1,992.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$324.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,992.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.03
|
| Rate for Payer: BCBS Transplant Transplant |
$286.55
|
| Rate for Payer: Blue Shield of California Commercial |
$458.18
|
| Rate for Payer: Blue Shield of California EPN |
$416.53
|
| Rate for Payer: Caremore Medicare Advantage |
$324.74
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Central Health Plan Commercial |
$382.07
|
| Rate for Payer: Cigna of CA HMO |
$334.31
|
| Rate for Payer: Cigna of CA PPO |
$334.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$324.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.74
|
| Rate for Payer: Galaxy Health WC |
$405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$286.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$358.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$532.58
|
| Rate for Payer: IEHP medi-cal |
$535.83
|
| Rate for Payer: IEHP Medicare Advantage |
$324.74
|
| Rate for Payer: Innovage PACE Commercial |
$487.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.16
|
| Rate for Payer: Multiplan Commercial |
$358.19
|
| Rate for Payer: Networks By Design Commercial |
$238.80
|
| Rate for Payer: Prime Health Services Commercial |
$405.95
|
| Rate for Payer: Prime Health Services Medicare |
$344.23
|
| Rate for Payer: Riverside University Health MISP |
$357.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.80
|
| Rate for Payer: United Healthcare All Other HMO |
$238.80
|
| Rate for Payer: United Healthcare HMO Rider |
$238.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$238.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
IP
|
$477.59
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
1720343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$429.83 |
| Rate for Payer: Blue Shield of California Commercial |
$358.19
|
| Rate for Payer: Blue Shield of California EPN |
$255.03
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Central Health Plan Commercial |
$382.07
|
| Rate for Payer: Cigna of CA HMO |
$334.31
|
| Rate for Payer: Cigna of CA PPO |
$334.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.04
|
| Rate for Payer: Galaxy Health WC |
$405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$286.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$358.19
|
| Rate for Payer: Networks By Design Commercial |
$238.80
|
| Rate for Payer: Prime Health Services Commercial |
$405.95
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
1781099
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: IEHP medi-cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Riverside University Health MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
1781099
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
Radial styloidectomy (separate procedure)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 25230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,044.21 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Radical excision external auditory canal lesion; without neck dissection
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 69150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,044.21 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 25115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,008.09 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 24149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greater
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 21936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: IEHP medi-cal |
$5,857.93
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Innovage PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health MISP |
$3,905.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 21558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: IEHP medi-cal |
$5,857.93
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Innovage PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health MISP |
$3,905.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 64625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,412.38 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: IEHP medi-cal |
$3,980.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Innovage PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health MISP |
$2,653.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$12,190.38
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$10,229.69 |
| Max. Negotiated Rate |
$12,190.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,229.69
|
| Rate for Payer: IEHP medi-cal |
$12,190.38
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$39,302.06
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$32,980.75 |
| Max. Negotiated Rate |
$39,302.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,980.75
|
| Rate for Payer: IEHP medi-cal |
$39,302.06
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$22,114.34
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$18,557.48 |
| Max. Negotiated Rate |
$22,114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,557.48
|
| Rate for Payer: IEHP medi-cal |
$22,114.34
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$7,189.02
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$6,032.75 |
| Max. Negotiated Rate |
$7,189.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,032.75
|
| Rate for Payer: IEHP medi-cal |
$7,189.02
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
OP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$161.16 |
| Max. Negotiated Rate |
$54,334.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$161.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$954.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$225.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.65
|
| Rate for Payer: BCBS Transplant Transplant |
$36,223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$37,309.90
|
| Rate for Payer: Blue Shield of California EPN |
$29,340.79
|
| Rate for Payer: Caremore Medicare Advantage |
$161.16
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Central Health Plan Commercial |
$48,297.60
|
| Rate for Payer: Cigna of CA HMO |
$38,638.08
|
| Rate for Payer: Cigna of CA PPO |
$44,675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$161.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.16
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$54,334.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45,279.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$264.31
|
| Rate for Payer: IEHP medi-cal |
$265.92
|
| Rate for Payer: IEHP Medicare Advantage |
$161.16
|
| Rate for Payer: Innovage PACE Commercial |
$241.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,268.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,074.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: Prime Health Services Medicare |
$170.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: Riverside University Health MISP |
$177.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,223.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Vantage Medical Group Senior |
$161.16
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
IP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12,074.40 |
| Max. Negotiated Rate |
$54,334.80 |
| Rate for Payer: Blue Shield of California Commercial |
$45,279.00
|
| Rate for Payer: Blue Shield of California EPN |
$32,238.65
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Central Health Plan Commercial |
$48,297.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,148.80
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$54,334.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,268.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,074.40
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
OP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.64
|
| Rate for Payer: BCBS Transplant Transplant |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: IEHP medi-cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: Riverside University Health MISP |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
OP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.57
|
| Rate for Payer: BCBS Transplant Transplant |
$22.93
|
| Rate for Payer: Blue Shield of California Commercial |
$24.03
|
| Rate for Payer: Blue Shield of California EPN |
$18.68
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Cigna of CA HMO |
$26.75
|
| Rate for Payer: Cigna of CA PPO |
$26.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.66
|
| Rate for Payer: IEHP medi-cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: Riverside University Health MISP |
$15.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.10
|
| Rate for Payer: United Healthcare All Other HMO |
$19.10
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
IP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Blue Shield of California Commercial |
$28.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Cigna of CA HMO |
$26.75
|
| Rate for Payer: Cigna of CA PPO |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
