|
DEFERASIROX 90 MG TABLET [206426]
|
Facility
|
OP
|
$72.75
|
|
|
Service Code
|
NDC 0078065415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$65.47 |
| Rate for Payer: Adventist Health Commercial |
$14.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.32
|
| Rate for Payer: Blue Shield of California Commercial |
$46.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.03
|
| Rate for Payer: Cash Price |
$32.74
|
| Rate for Payer: Central Health Plan Commercial |
$58.20
|
| Rate for Payer: Cigna of CA HMO |
$50.92
|
| Rate for Payer: Cigna of CA PPO |
$50.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.10
|
| Rate for Payer: EPIC Health Plan Senior |
$29.10
|
| Rate for Payer: Galaxy Health WC |
$61.84
|
| Rate for Payer: Global Benefits Group Commercial |
$43.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.92
|
| Rate for Payer: Multiplan Commercial |
$54.56
|
| Rate for Payer: Networks By Design Commercial |
$47.29
|
| Rate for Payer: Prime Health Services Commercial |
$61.84
|
| Rate for Payer: Riverside University Health System MISP |
$29.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.38
|
| Rate for Payer: United Healthcare All Other HMO |
$36.38
|
| Rate for Payer: United Healthcare HMO Rider |
$36.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.84
|
| Rate for Payer: Vantage Medical Group Senior |
$61.84
|
|
|
DEFERASIROX 90 MG TABLET [206426]
|
Facility
|
IP
|
$72.75
|
|
|
Service Code
|
NDC 0078065415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$65.47 |
| Rate for Payer: Adventist Health Commercial |
$14.55
|
| Rate for Payer: Blue Shield of California Commercial |
$58.35
|
| Rate for Payer: Blue Shield of California EPN |
$36.67
|
| Rate for Payer: Cash Price |
$32.74
|
| Rate for Payer: Central Health Plan Commercial |
$58.20
|
| Rate for Payer: Cigna of CA HMO |
$50.92
|
| Rate for Payer: Cigna of CA PPO |
$50.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.10
|
| Rate for Payer: EPIC Health Plan Senior |
$29.10
|
| Rate for Payer: Galaxy Health WC |
$61.84
|
| Rate for Payer: Global Benefits Group Commercial |
$43.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$54.56
|
| Rate for Payer: Networks By Design Commercial |
$47.29
|
| Rate for Payer: Prime Health Services Commercial |
$61.84
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
IP
|
$49.44
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California Commercial |
$39.65
|
| Rate for Payer: Blue Shield of California EPN |
$24.92
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Central Health Plan Commercial |
$39.55
|
| Rate for Payer: Cigna of CA HMO |
$34.61
|
| Rate for Payer: Cigna of CA PPO |
$34.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.02
|
| Rate for Payer: Global Benefits Group Commercial |
$29.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: Networks By Design Commercial |
$24.72
|
| Rate for Payer: Prime Health Services Commercial |
$42.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.55
|
| Rate for Payer: United Healthcare All Other HMO |
$18.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.19
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
OP
|
$49.44
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Central Health Plan Commercial |
$39.55
|
| Rate for Payer: Cigna of CA HMO |
$34.61
|
| Rate for Payer: Cigna of CA PPO |
$34.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.02
|
| Rate for Payer: Global Benefits Group Commercial |
$29.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.61
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: Networks By Design Commercial |
$24.72
|
| Rate for Payer: Prime Health Services Commercial |
$42.02
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.55
|
| Rate for Payer: United Healthcare All Other HMO |
$18.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.02
|
| Rate for Payer: Vantage Medical Group Senior |
$42.02
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$14.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Riverside University Health System MISP |
$7.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
OP
|
$15.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Riverside University Health System MISP |
$7.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.21
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$14.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$77,135.42
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$48,717.11 |
| Max. Negotiated Rate |
$77,135.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$48,717.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58,054.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77,135.42
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$63,408.72
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$40,047.61 |
| Max. Negotiated Rate |
$63,408.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,047.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47,723.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63,408.72
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$53,404.23
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$33,728.99 |
| Max. Negotiated Rate |
$53,404.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$33,728.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40,193.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,404.23
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$104,486.11
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$65,991.23 |
| Max. Negotiated Rate |
$104,486.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$65,991.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78,639.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104,486.11
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$595.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Adventist Health Commercial |
$119.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.40
|
| Rate for Payer: Blue Shield of California Commercial |
$377.36
|
| Rate for Payer: Blue Shield of California EPN |
$237.48
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Central Health Plan Commercial |
$476.16
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$416.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.08
|
| Rate for Payer: EPIC Health Plan Senior |
$238.08
|
| Rate for Payer: Galaxy Health WC |
$505.92
|
| Rate for Payer: Global Benefits Group Commercial |
$357.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$416.64
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: Networks By Design Commercial |
$297.60
|
| Rate for Payer: Prime Health Services Commercial |
$505.92
|
| Rate for Payer: Riverside University Health System MISP |
$238.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.38
|
| Rate for Payer: United Healthcare All Other HMO |
$217.43
|
| Rate for Payer: United Healthcare HMO Rider |
$212.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.92
|
| Rate for Payer: Vantage Medical Group Senior |
$505.92
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Adventist Health Commercial |
$119.04
|
| Rate for Payer: Blue Shield of California Commercial |
$477.35
|
| Rate for Payer: Blue Shield of California EPN |
$299.98
|
| Rate for Payer: Cash Price |
$267.84
|
| Rate for Payer: Central Health Plan Commercial |
$476.16
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$416.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.08
|
| Rate for Payer: EPIC Health Plan Senior |
$238.08
|
| Rate for Payer: Galaxy Health WC |
$505.92
|
| Rate for Payer: Global Benefits Group Commercial |
$357.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: Networks By Design Commercial |
$297.60
|
| Rate for Payer: Prime Health Services Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.38
|
| Rate for Payer: United Healthcare All Other HMO |
$217.43
|
| Rate for Payer: United Healthcare HMO Rider |
$212.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.93
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]
|
Facility
|
IP
|
$586.14
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.23 |
| Max. Negotiated Rate |
$527.53 |
| Rate for Payer: Adventist Health Commercial |
$117.23
|
| Rate for Payer: Blue Shield of California Commercial |
$470.08
|
| Rate for Payer: Blue Shield of California EPN |
$295.41
|
| Rate for Payer: Cash Price |
$263.76
|
| Rate for Payer: Central Health Plan Commercial |
$468.91
|
| Rate for Payer: Cigna of CA HMO |
$410.30
|
| Rate for Payer: Cigna of CA PPO |
$410.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.46
|
| Rate for Payer: EPIC Health Plan Senior |
$234.46
|
| Rate for Payer: Galaxy Health WC |
$498.22
|
| Rate for Payer: Global Benefits Group Commercial |
$351.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$527.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.23
|
| Rate for Payer: Multiplan Commercial |
$439.61
|
| Rate for Payer: Networks By Design Commercial |
$293.07
|
| Rate for Payer: Prime Health Services Commercial |
$498.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.98
|
| Rate for Payer: United Healthcare All Other HMO |
$214.12
|
| Rate for Payer: United Healthcare HMO Rider |
$209.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.96
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]
|
Facility
|
OP
|
$586.14
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$527.53 |
| Rate for Payer: Adventist Health Commercial |
$117.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$8.06
|
| Rate for Payer: Blue Shield of California EPN |
$7.33
|
| Rate for Payer: Cash Price |
$263.76
|
| Rate for Payer: Cash Price |
$263.76
|
| Rate for Payer: Central Health Plan Commercial |
$468.91
|
| Rate for Payer: Cigna of CA HMO |
$410.30
|
| Rate for Payer: Cigna of CA PPO |
$410.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$498.22
|
| Rate for Payer: Global Benefits Group Commercial |
$351.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$527.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$439.61
|
| Rate for Payer: Networks By Design Commercial |
$293.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.48
|
| Rate for Payer: Prime Health Services Commercial |
$498.22
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Riverside University Health System MISP |
$4.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.98
|
| Rate for Payer: United Healthcare All Other HMO |
$214.12
|
| Rate for Payer: United Healthcare HMO Rider |
$209.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.93
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$19,015.96
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$12,010.08 |
| Max. Negotiated Rate |
$19,015.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,010.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,312.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,015.96
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$11,223.07
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$7,088.26 |
| Max. Negotiated Rate |
$11,223.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,088.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,446.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,223.07
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$34,998.57
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$22,104.36 |
| Max. Negotiated Rate |
$34,998.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,104.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,341.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,998.57
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$14,099.33
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$8,904.84 |
| Max. Negotiated Rate |
$14,099.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,904.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,611.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,099.33
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$61,141.67
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$61,141.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,141.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,495.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,294.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,354.14
|
| Rate for Payer: EPIC Health Plan Senior |
$36,236.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,941.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,118.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,142.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,941.90
|
| Rate for Payer: Prime Health Services Medicare |
$34,918.41
|
| 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
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$34,098.90
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$34,098.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,098.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,026.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,837.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,971.44
|
| Rate for Payer: EPIC Health Plan Senior |
$20,647.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,770.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,278.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,152.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,770.57
|
| Rate for Payer: Prime Health Services Medicare |
$19,896.80
|
| 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
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS, CHIN, NECK, AXILLAE, GENITALIA, HANDS, OR FEET
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$435.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$435.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
OP
|
$2,508.16
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$2,257.34 |
| Rate for Payer: Adventist Health Commercial |
$501.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.94
|
| Rate for Payer: Blue Shield of California Commercial |
$38.24
|
| Rate for Payer: Blue Shield of California EPN |
$34.76
|
| Rate for Payer: Cash Price |
$1,128.67
|
| Rate for Payer: Cash Price |
$1,128.67
|
| Rate for Payer: Central Health Plan Commercial |
$2,006.53
|
| Rate for Payer: Cigna of CA HMO |
$1,755.71
|
| Rate for Payer: Cigna of CA PPO |
$1,755.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,755.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.66
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
| Rate for Payer: Galaxy Health WC |
$2,131.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,257.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$49.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,592.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.33
|
| Rate for Payer: Multiplan Commercial |
$1,881.12
|
| Rate for Payer: Networks By Design Commercial |
$1,254.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,131.94
|
| Rate for Payer: Prime Health Services Medicare |
$31.91
|
| Rate for Payer: Riverside University Health System MISP |
$33.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$941.31
|
| Rate for Payer: United Healthcare All Other HMO |
$916.23
|
| Rate for Payer: United Healthcare HMO Rider |
$896.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$821.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Vantage Medical Group Senior |
$33.11
|
|
