|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$15,781.17
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$9,967.06 |
| Max. Negotiated Rate |
$15,781.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,967.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,877.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,781.17
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$36,676.38
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$23,164.03 |
| Max. Negotiated Rate |
$36,676.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,164.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,603.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,676.38
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$35,999.62
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$22,736.60 |
| Max. Negotiated Rate |
$35,999.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,736.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,094.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,999.62
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$13,035.84
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$8,233.16 |
| Max. Negotiated Rate |
$13,035.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,233.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,811.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,035.84
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$8,612.68
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$5,439.59 |
| Max. Negotiated Rate |
$8,612.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,439.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,482.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,612.68
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$7,327.62
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$4,627.97 |
| Max. Negotiated Rate |
$7,327.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,627.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,515.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,327.62
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$16,236.19
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$16,236.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,236.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,487.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,683.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,526.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10,350.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,409.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,173.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,609.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,409.90
|
| Rate for Payer: Prime Health Services Medicare |
$9,974.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$45,929.29
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$45,929.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,929.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,668.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,536.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,200.67
|
| Rate for Payer: EPIC Health Plan Senior |
$27,467.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,970.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,958.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,459.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,970.10
|
| Rate for Payer: Prime Health Services Medicare |
$26,468.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$23,234.41
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$23,234.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,234.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,008.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,012.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,577.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,384.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,077.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,308.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,523.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,077.21
|
| Rate for Payer: Prime Health Services Medicare |
$13,861.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$37,257.18
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$37,257.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,257.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,066.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,694.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,702.29
|
| Rate for Payer: EPIC Health Plan Senior |
$22,468.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,425.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,595.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,370.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,425.63
|
| Rate for Payer: Prime Health Services Medicare |
$21,651.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$12,189.89
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$7,698.88 |
| Max. Negotiated Rate |
$12,189.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,698.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,174.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,189.89
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$9,275.34
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$5,858.11 |
| Max. Negotiated Rate |
$9,275.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,858.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,980.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,275.34
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$36,553.51
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$23,086.43 |
| Max. Negotiated Rate |
$36,553.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,086.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,511.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,553.51
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$18,532.56
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$11,704.78 |
| Max. Negotiated Rate |
$18,532.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,704.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,948.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,532.56
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
IP
|
$102.20
|
|
|
Service Code
|
NDC 5024213001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$91.98 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Blue Shield of California Commercial |
$81.96
|
| Rate for Payer: Blue Shield of California EPN |
$51.51
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: Central Health Plan Commercial |
$81.76
|
| Rate for Payer: Cigna of CA HMO |
$71.54
|
| Rate for Payer: Cigna of CA PPO |
$71.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.88
|
| Rate for Payer: EPIC Health Plan Senior |
$40.88
|
| Rate for Payer: Galaxy Health WC |
$86.87
|
| Rate for Payer: Global Benefits Group Commercial |
$61.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.44
|
| Rate for Payer: Multiplan Commercial |
$76.65
|
| Rate for Payer: Networks By Design Commercial |
$66.43
|
| Rate for Payer: Prime Health Services Commercial |
$86.87
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
NDC 5024213001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$91.98 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.45
|
| Rate for Payer: Blue Shield of California Commercial |
$64.79
|
| Rate for Payer: Blue Shield of California EPN |
$40.78
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: Central Health Plan Commercial |
$81.76
|
| Rate for Payer: Cigna of CA HMO |
$71.54
|
| Rate for Payer: Cigna of CA PPO |
$71.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.88
|
| Rate for Payer: EPIC Health Plan Senior |
$40.88
|
| Rate for Payer: Galaxy Health WC |
$86.87
|
| Rate for Payer: Global Benefits Group Commercial |
$61.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.54
|
| Rate for Payer: Multiplan Commercial |
$76.65
|
| Rate for Payer: Networks By Design Commercial |
$66.43
|
| Rate for Payer: Prime Health Services Commercial |
$86.87
|
| Rate for Payer: Riverside University Health System MISP |
$40.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.10
|
| Rate for Payer: United Healthcare All Other HMO |
$51.10
|
| Rate for Payer: United Healthcare HMO Rider |
$51.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.87
|
| Rate for Payer: Vantage Medical Group Senior |
$86.87
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
IP
|
$30,041.68
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,008.34 |
| Max. Negotiated Rate |
$27,037.51 |
| Rate for Payer: Adventist Health Commercial |
$6,008.34
|
| Rate for Payer: Blue Shield of California Commercial |
$24,093.43
|
| Rate for Payer: Blue Shield of California EPN |
$15,141.01
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Central Health Plan Commercial |
$24,033.34
|
| Rate for Payer: Cigna of CA HMO |
$21,029.18
|
| Rate for Payer: Cigna of CA PPO |
$21,029.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,029.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,016.67
|
| Rate for Payer: EPIC Health Plan Senior |
$12,016.67
|
| Rate for Payer: Galaxy Health WC |
$25,535.43
|
| Rate for Payer: Global Benefits Group Commercial |
$18,025.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,037.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,076.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,724.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,008.34
|
| Rate for Payer: Multiplan Commercial |
$22,531.26
|
| Rate for Payer: Networks By Design Commercial |
$15,020.84
|
| Rate for Payer: Prime Health Services Commercial |
$25,535.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,274.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10,974.23
|
| Rate for Payer: United Healthcare HMO Rider |
$10,736.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,838.65
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
OP
|
$30,041.68
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,544.94 |
| Max. Negotiated Rate |
$27,037.51 |
| Rate for Payer: Adventist Health Commercial |
$6,008.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,130.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,799.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,257.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,064.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,207.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,915.82
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Central Health Plan Commercial |
$24,033.34
|
| Rate for Payer: Cigna of CA HMO |
$21,029.18
|
| Rate for Payer: Cigna of CA PPO |
$21,029.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,799.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,029.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$2,799.43
|
| Rate for Payer: Galaxy Health WC |
$25,535.43
|
| Rate for Payer: Global Benefits Group Commercial |
$18,025.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,037.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,544.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,076.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,649.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,562.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,008.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,410.22
|
| Rate for Payer: Multiplan Commercial |
$22,531.26
|
| Rate for Payer: Networks By Design Commercial |
$15,020.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,544.94
|
| Rate for Payer: Prime Health Services Commercial |
$25,535.43
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.64
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,025.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,025.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,274.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10,974.23
|
| Rate for Payer: United Healthcare HMO Rider |
$10,736.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,838.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,544.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2,799.43
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 6498034003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 6498034003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
NDC 0054028259
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
NDC 0054028259
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 6498034214
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
| Rate for Payer: Riverside University Health System MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 6586232904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.32
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
NDC 6586232904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.32
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
| Rate for Payer: Riverside University Health System MISP |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
