|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
IP
|
$1.24
|
|
|
Service Code
|
NDC 0115-5211-16
|
| Hospital Charge Code |
1711918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
OP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
ERX12218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.23
|
| Rate for Payer: BCBS Transplant Transplant |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.83
|
| Rate for Payer: IEHP medi-cal |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: Riverside University Health MISP |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
IP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
ERX12218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
OP
|
$33.60
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4080399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$102.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.95
|
| Rate for Payer: BCBS Transplant Transplant |
$20.15
|
| Rate for Payer: BCBS Transplant Transplant |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$36.68
|
| Rate for Payer: Blue Shield of California Commercial |
$36.68
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.20
|
| Rate for Payer: IEHP medi-cal |
$10.90
|
| Rate for Payer: IEHP medi-cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
IP
|
$33.59
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4080399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.23 |
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
IP
|
$33.59
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4082134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.23 |
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
OP
|
$33.59
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4082134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$102.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.95
|
| Rate for Payer: BCBS Transplant Transplant |
$20.15
|
| Rate for Payer: BCBS Transplant Transplant |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$36.68
|
| Rate for Payer: Blue Shield of California Commercial |
$36.68
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.87
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.20
|
| Rate for Payer: IEHP medi-cal |
$10.90
|
| Rate for Payer: IEHP medi-cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
OP
|
$10.95
|
|
|
Service Code
|
NDC 50484-010-90
|
| Hospital Charge Code |
NDG9682B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.47
|
| Rate for Payer: BCBS Transplant Transplant |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Central Health Plan Commercial |
$8.76
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$9.31
|
| Rate for Payer: Global Benefits Group Commercial |
$6.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.21
|
| Rate for Payer: IEHP medi-cal |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$8.21
|
| Rate for Payer: Networks By Design Commercial |
$7.12
|
| Rate for Payer: Prime Health Services Commercial |
$9.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.57
|
| Rate for Payer: Riverside University Health MISP |
$4.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$9.31
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
OP
|
$11.52
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
1743273
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.81
|
| Rate for Payer: BCBS Transplant Transplant |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7.25
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Central Health Plan Commercial |
$9.22
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.64
|
| Rate for Payer: IEHP medi-cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.49
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: Riverside University Health MISP |
$4.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO |
$5.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.79
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
IP
|
$11.52
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
1743273
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Blue Shield of California Commercial |
$8.64
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Central Health Plan Commercial |
$9.22
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.49
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
IP
|
$10.95
|
|
|
Service Code
|
NDC 50484-010-90
|
| Hospital Charge Code |
NDG9682B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Blue Shield of California Commercial |
$8.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.85
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Central Health Plan Commercial |
$8.76
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$9.31
|
| Rate for Payer: Global Benefits Group Commercial |
$6.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$8.21
|
| Rate for Payer: Networks By Design Commercial |
$7.12
|
| Rate for Payer: Prime Health Services Commercial |
$9.31
|
|
|
Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| 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 |
$1,141.93
|
| Rate for Payer: Center for Health Promotion Commercial |
$846.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: IEHP medi-cal |
$1,884.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Innovage PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health MISP |
$1,256.12
|
| 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 |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 44388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,141.93 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| 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 |
$1,141.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: IEHP medi-cal |
$1,884.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Innovage PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health MISP |
$1,256.12
|
| 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 |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
Colpocleisis (Le Fort type)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 57120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| 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 |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,441.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,162.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,385.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,441.39
|
| 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 |
$12,907.72
|
| 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 |
$9,441.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,162.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,745.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,441.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,441.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,483.88
|
| Rate for Payer: IEHP medi-cal |
$15,578.29
|
| Rate for Payer: IEHP Medicare Advantage |
$9,441.39
|
| Rate for Payer: Innovage PACE Commercial |
$14,162.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,441.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,651.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,651.46
|
| Rate for Payer: Multiplan WC |
$12,907.72
|
| Rate for Payer: Preferred Health Network WC |
$13,171.14
|
| Rate for Payer: Prime Health Services Medicare |
$10,007.87
|
| Rate for Payer: Prime Health Services WC |
$12,776.01
|
| Rate for Payer: Riverside University Health MISP |
$10,385.53
|
| 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 |
$14,162.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,385.53
|
| Rate for Payer: Vantage Medical Group Senior |
$9,441.39
|
|
|
Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 57283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,441.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,162.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,385.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,441.39
|
| 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 |
$12,907.72
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$9,441.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,162.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,745.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,441.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,441.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,483.88
|
| Rate for Payer: IEHP medi-cal |
$15,578.29
|
| Rate for Payer: IEHP Medicare Advantage |
$9,441.39
|
| Rate for Payer: Innovage PACE Commercial |
$14,162.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,441.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,651.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,651.46
|
| Rate for Payer: Multiplan WC |
$12,907.72
|
| Rate for Payer: Preferred Health Network WC |
$13,171.14
|
| Rate for Payer: Prime Health Services Medicare |
$10,007.87
|
| Rate for Payer: Prime Health Services WC |
$12,776.01
|
| Rate for Payer: Riverside University Health MISP |
$10,385.53
|
| 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 |
$14,162.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,385.53
|
| Rate for Payer: Vantage Medical Group Senior |
$9,441.39
|
|
|
Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage
|
Facility
OP
|
$6,248.00
|
|
|
Service Code
|
CPT 57454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$400.82 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: IEHP medi-cal |
$661.35
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Innovage PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health MISP |
$440.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 57421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,004.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,004.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,004.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,647.27
|
| Rate for Payer: IEHP medi-cal |
$1,657.31
|
| Rate for Payer: IEHP Medicare Advantage |
$1,004.43
|
| Rate for Payer: Innovage PACE Commercial |
$1,506.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,004.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.94
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.70
|
| Rate for Payer: Riverside University Health MISP |
$1,104.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed;
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| 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: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| 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 |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; with enterocele repair
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,214.57 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| 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: 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 |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| 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 |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
COMPOUNDING VEHICLE (FLAVOR SWEET) NO 8 ORAL LIQUID [37965]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
COMPOUNDING VEHICLE (FLAVOR SWEET) NO 8 ORAL LIQUID [37965]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
COMPOUNDING VEHICLE (ORA-PLUS) SUSPENSION SUGAR-FREE NO.20 ORAL [211818]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 574030316
|
| Hospital Charge Code |
NDG211818
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
COMPOUNDING VEHICLE (ORA-PLUS) SUSPENSION SUGAR-FREE NO.20 ORAL [211818]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 574030316
|
| Hospital Charge Code |
NDG211818
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
COMPOUNDING VEHICLE (ORA-SWEET SF) SUGAR-FREE NO.9 ORAL LIQUID [120588]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 395009416
|
| Hospital Charge Code |
NDG120588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
