|
Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| 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 |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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
|
|
|
Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| 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 |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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
|
|
|
Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| 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 |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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
|
|
|
Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| 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 |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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
|
|
|
Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| 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 |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| 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 |
$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 |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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
|
|
|
Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| 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 |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| 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 |
$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 |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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
|
|
|
Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26502
|
|
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
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
IP
|
$7.20
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
1796133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$46.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$49.49
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$52.58
|
| Rate for Payer: Global Benefits Group Commercial |
$37.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$30.93
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$52.58
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
1796133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$114.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.32
|
| Rate for Payer: BCBS Transplant Transplant |
$37.12
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$80.18
|
| Rate for Payer: Blue Shield of California Commercial |
$80.18
|
| Rate for Payer: Blue Shield of California EPN |
$72.89
|
| Rate for Payer: Blue Shield of California EPN |
$72.89
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$49.49
|
| Rate for Payer: Cigna of CA HMO |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$43.30
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.74
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$52.58
|
| Rate for Payer: Global Benefits Group Commercial |
$37.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$46.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: IEHP medi-cal |
$3.39
|
| Rate for Payer: IEHP medi-cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.37
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$30.93
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$52.58
|
| Rate for Payer: Riverside University Health MISP |
$24.74
|
| Rate for Payer: Riverside University Health MISP |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$30.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$30.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$52.58
|
|
|
REHABILITATION
|
Facility
IP
|
$14,156.49
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$11,879.57 |
| Max. Negotiated Rate |
$14,156.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,879.57
|
| Rate for Payer: IEHP medi-cal |
$14,156.49
|
|
|
REHABILITATION
|
Facility
IP
|
$18,031.30
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$15,131.16 |
| Max. Negotiated Rate |
$18,031.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,131.16
|
| Rate for Payer: IEHP medi-cal |
$18,031.30
|
|
|
REHABILITATION
|
Facility
IP
|
$11,549.70
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$9,692.05 |
| Max. Negotiated Rate |
$11,549.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,692.05
|
| Rate for Payer: IEHP medi-cal |
$11,549.70
|
|
|
REHABILITATION
|
Facility
IP
|
$22,088.98
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$18,536.21 |
| Max. Negotiated Rate |
$22,088.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,536.21
|
| Rate for Payer: IEHP medi-cal |
$22,088.98
|
|
|
Release, intrinsic muscles of hand, each muscle
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 26593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$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 |
$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 |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| 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
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
OP
|
$104.15
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
ERX229912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$93.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$88.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.53
|
| Rate for Payer: BCBS Transplant Transplant |
$62.49
|
| Rate for Payer: Blue Shield of California Commercial |
$65.51
|
| Rate for Payer: Blue Shield of California EPN |
$50.93
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Central Health Plan Commercial |
$83.32
|
| Rate for Payer: Cigna of CA HMO |
$72.90
|
| Rate for Payer: Cigna of CA PPO |
$72.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.66
|
| Rate for Payer: Galaxy Health WC |
$88.53
|
| Rate for Payer: Global Benefits Group Commercial |
$62.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$78.11
|
| Rate for Payer: IEHP medi-cal |
$36.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.83
|
| Rate for Payer: Multiplan Commercial |
$78.11
|
| Rate for Payer: Networks By Design Commercial |
$67.70
|
| Rate for Payer: Prime Health Services Commercial |
$88.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$62.49
|
| Rate for Payer: Riverside University Health MISP |
$41.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.08
|
| Rate for Payer: United Healthcare All Other HMO |
$52.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.53
|
| Rate for Payer: Vantage Medical Group Senior |
$88.53
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
IP
|
$104.15
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
ERX229912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$93.74 |
| Rate for Payer: Blue Shield of California Commercial |
$78.11
|
| Rate for Payer: Blue Shield of California EPN |
$55.62
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Central Health Plan Commercial |
$83.32
|
| Rate for Payer: Cigna of CA HMO |
$72.90
|
| Rate for Payer: Cigna of CA PPO |
$72.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: Galaxy Health WC |
$88.53
|
| Rate for Payer: Global Benefits Group Commercial |
$62.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.83
|
| Rate for Payer: Multiplan Commercial |
$78.11
|
| Rate for Payer: Networks By Design Commercial |
$67.70
|
| Rate for Payer: Prime Health Services Commercial |
$88.53
|
|
|
REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE) [228088]
|
Facility
OP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.24
|
| Rate for Payer: BCBS Transplant Transplant |
$18.72
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$15.26
|
| Rate for Payer: Caremore Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.94
|
| Rate for Payer: IEHP medi-cal |
$10.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6.06
|
| Rate for Payer: Innovage PACE Commercial |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Medicare |
$6.42
|
| Rate for Payer: Riverside University Health MISP |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.60
|
| Rate for Payer: United Healthcare All Other HMO |
$15.60
|
| Rate for Payer: United Healthcare HMO Rider |
$15.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE) [228088]
|
Facility
IP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Blue Shield of California Commercial |
$23.40
|
| Rate for Payer: Blue Shield of California EPN |
$16.66
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.48
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
|
|
REMDESIVIR 100 MG/20 ML VIAL - COMMERCIAL PRODUCT [4082058624]
|
Facility
IP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Blue Shield of California Commercial |
$23.40
|
| Rate for Payer: Blue Shield of California EPN |
$16.66
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.48
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
|
|
REMDESIVIR 100 MG/20 ML VIAL - COMMERCIAL PRODUCT [4082058624]
|
Facility
OP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.24
|
| Rate for Payer: BCBS Transplant Transplant |
$18.72
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$15.26
|
| Rate for Payer: Caremore Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.94
|
| Rate for Payer: IEHP medi-cal |
$10.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6.06
|
| Rate for Payer: Innovage PACE Commercial |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Medicare |
$6.42
|
| Rate for Payer: Riverside University Health MISP |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.60
|
| Rate for Payer: United Healthcare All Other HMO |
$15.60
|
| Rate for Payer: United Healthcare HMO Rider |
$15.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
IP
|
$685.78
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
ERX4082058626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$617.20 |
| Rate for Payer: Blue Shield of California Commercial |
$514.34
|
| Rate for Payer: Blue Shield of California EPN |
$366.21
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Central Health Plan Commercial |
$548.62
|
| Rate for Payer: Cigna of CA HMO |
$480.05
|
| Rate for Payer: Cigna of CA PPO |
$480.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.31
|
| Rate for Payer: Galaxy Health WC |
$582.91
|
| Rate for Payer: Global Benefits Group Commercial |
$411.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$617.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.16
|
| Rate for Payer: Multiplan Commercial |
$514.34
|
| Rate for Payer: Networks By Design Commercial |
$342.89
|
| Rate for Payer: Prime Health Services Commercial |
$582.91
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
OP
|
$685.78
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
ERX4082058626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$617.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.24
|
| Rate for Payer: BCBS Transplant Transplant |
$411.47
|
| Rate for Payer: Blue Shield of California Commercial |
$431.36
|
| Rate for Payer: Blue Shield of California EPN |
$335.35
|
| Rate for Payer: Caremore Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Central Health Plan Commercial |
$548.62
|
| Rate for Payer: Cigna of CA HMO |
$480.05
|
| Rate for Payer: Cigna of CA PPO |
$480.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$582.91
|
| Rate for Payer: Global Benefits Group Commercial |
$411.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$617.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$514.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.94
|
| Rate for Payer: IEHP medi-cal |
$10.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6.06
|
| Rate for Payer: Innovage PACE Commercial |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$514.34
|
| Rate for Payer: Networks By Design Commercial |
$342.89
|
| Rate for Payer: Prime Health Services Commercial |
$582.91
|
| Rate for Payer: Prime Health Services Medicare |
$6.42
|
| Rate for Payer: Riverside University Health MISP |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$342.89
|
| Rate for Payer: United Healthcare All Other HMO |
$342.89
|
| Rate for Payer: United Healthcare HMO Rider |
$342.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$342.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Blue Shield of California Commercial |
$55.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.25
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.45
|
| Rate for Payer: BCBS Transplant Transplant |
$44.13
|
| Rate for Payer: Blue Shield of California Commercial |
$46.26
|
| Rate for Payer: Blue Shield of California EPN |
$35.97
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Central Health Plan Commercial |
$58.84
|
| Rate for Payer: Cigna of CA HMO |
$47.07
|
| Rate for Payer: Cigna of CA PPO |
$54.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.16
|
| Rate for Payer: IEHP medi-cal |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
| Rate for Payer: Riverside University Health MISP |
$29.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$36.78
|
| Rate for Payer: United Healthcare HMO Rider |
$36.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$69.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.59
|
| Rate for Payer: BCBS Transplant Transplant |
$46.30
|
| Rate for Payer: Blue Shield of California Commercial |
$48.54
|
| Rate for Payer: Blue Shield of California EPN |
$37.74
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$61.74
|
| Rate for Payer: Cigna of CA HMO |
$49.39
|
| Rate for Payer: Cigna of CA PPO |
$57.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.88
|
| Rate for Payer: IEHP medi-cal |
$27.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
| Rate for Payer: Riverside University Health MISP |
$30.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
