|
REHABILITATION WITH CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 945
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 946
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
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
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
|
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
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 (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 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 |
$34,005.88 |
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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: 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
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
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$44.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.42
|
| Rate for Payer: BCBS Transplant Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.23
|
| Rate for Payer: Blue Shield of California EPN |
$35.94
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$47.04
|
| Rate for Payer: Cigna of CA PPO |
$54.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$55.12
|
| Rate for Payer: IEHP medi-cal |
$25.72
|
| 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
|
| Rate for Payer: Riverside University Health MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$55.16
|
| Rate for Payer: Blue Shield of California EPN |
$39.28
|
| 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: EPIC Health Plan Commercial |
$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: 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
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.42
|
| Rate for Payer: BCBS Transplant Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.23
|
| Rate for Payer: Blue Shield of California EPN |
$35.94
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$47.04
|
| Rate for Payer: Cigna of CA PPO |
$54.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$55.12
|
| Rate for Payer: IEHP medi-cal |
$25.72
|
| 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
|
| Rate for Payer: Riverside University Health MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$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
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-00
|
| 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$57.88
|
| Rate for Payer: Blue Shield of California EPN |
$41.21
|
| 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: EPIC Health Plan Commercial |
$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: 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$57.88
|
| Rate for Payer: Blue Shield of California EPN |
$41.21
|
| 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: EPIC Health Plan Commercial |
$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: 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| 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
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-00
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$55.16
|
| Rate for Payer: Blue Shield of California EPN |
$39.28
|
| 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: EPIC Health Plan Commercial |
$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: 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
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.91
|
| Rate for Payer: BCBS Transplant Transplant |
$88.26
|
| Rate for Payer: Blue Shield of California Commercial |
$92.53
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Central Health Plan Commercial |
$117.68
|
| Rate for Payer: Cigna of CA HMO |
$94.14
|
| Rate for Payer: Cigna of CA PPO |
$108.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$110.32
|
| Rate for Payer: IEHP medi-cal |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.42
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
| Rate for Payer: Riverside University Health MISP |
$58.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.55
|
| Rate for Payer: United Healthcare All Other HMO |
$73.55
|
| Rate for Payer: United Healthcare HMO Rider |
$73.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$110.32
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Central Health Plan Commercial |
$117.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.42
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
|
