|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
IP
|
$0.75
|
|
|
Service Code
|
NDC 64980-342-14
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| 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
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
OP
|
$0.75
|
|
|
Service Code
|
NDC 64980-342-14
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| 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: BCBS Transplant Transplant |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| 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: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: IEHP medi-cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: Riverside University Health 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 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 65862-329-04
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| 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: EPIC Health Plan Commercial |
$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 |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.10
|
| 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
|
$3.35
|
|
|
Service Code
|
NDC 69543-131-20
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: BCBS Transplant Transplant |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.68
|
| Rate for Payer: Cigna of CA HMO |
$2.34
|
| Rate for Payer: Cigna of CA PPO |
$2.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.51
|
| Rate for Payer: IEHP medi-cal |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.01
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2.85
|
|
|
ALFENTANIL 500 MCG/ML INJECTION SOLUTION [25268]
|
Facility
OP
|
$4.20
|
|
|
Service Code
|
CPT J0216
|
| Hospital Charge Code |
1737010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.48
|
| Rate for Payer: BCBS Transplant Transplant |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.15
|
| Rate for Payer: IEHP medi-cal |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
ALFENTANIL 500 MCG/ML INJECTION SOLUTION [25268]
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
CPT J0216
|
| Hospital Charge Code |
1737010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 13668-021-01
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 47335-956-88
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: Riverside University Health MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 13668-021-01
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 47335-956-88
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]
|
Facility
IP
|
$1,123.61
|
|
|
Service Code
|
CPT J0221
|
| Hospital Charge Code |
1755758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,011.25 |
| Rate for Payer: Blue Shield of California Commercial |
$842.71
|
| Rate for Payer: Blue Shield of California EPN |
$600.01
|
| Rate for Payer: Cash Price |
$505.62
|
| Rate for Payer: Central Health Plan Commercial |
$898.89
|
| Rate for Payer: Cigna of CA HMO |
$786.53
|
| Rate for Payer: Cigna of CA PPO |
$786.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.44
|
| Rate for Payer: Galaxy Health WC |
$955.07
|
| Rate for Payer: Global Benefits Group Commercial |
$674.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,011.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$749.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.72
|
| Rate for Payer: Multiplan Commercial |
$842.71
|
| Rate for Payer: Networks By Design Commercial |
$561.80
|
| Rate for Payer: Prime Health Services Commercial |
$955.07
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]
|
Facility
OP
|
$1,123.61
|
|
|
Service Code
|
CPT J0221
|
| Hospital Charge Code |
1755758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$1,222.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$197.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,222.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$246.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$217.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$217.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$277.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.37
|
| Rate for Payer: BCBS Transplant Transplant |
$674.17
|
| Rate for Payer: Blue Shield of California Commercial |
$217.58
|
| Rate for Payer: Blue Shield of California EPN |
$197.80
|
| Rate for Payer: Caremore Medicare Advantage |
$197.28
|
| Rate for Payer: Cash Price |
$505.62
|
| Rate for Payer: Cash Price |
$505.62
|
| Rate for Payer: Central Health Plan Commercial |
$898.89
|
| Rate for Payer: Cigna of CA HMO |
$786.53
|
| Rate for Payer: Cigna of CA PPO |
$786.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$197.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$197.28
|
| Rate for Payer: Galaxy Health WC |
$955.07
|
| Rate for Payer: Global Benefits Group Commercial |
$674.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,011.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$842.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$323.54
|
| Rate for Payer: IEHP medi-cal |
$325.51
|
| Rate for Payer: IEHP Medicare Advantage |
$197.28
|
| Rate for Payer: Innovage PACE Commercial |
$295.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$749.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.35
|
| Rate for Payer: Multiplan Commercial |
$842.71
|
| Rate for Payer: Networks By Design Commercial |
$561.80
|
| Rate for Payer: Prime Health Services Commercial |
$955.07
|
| Rate for Payer: Prime Health Services Medicare |
$209.11
|
| Rate for Payer: Riverside University Health MISP |
$217.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$674.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$674.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.80
|
| Rate for Payer: United Healthcare All Other HMO |
$561.80
|
| Rate for Payer: United Healthcare HMO Rider |
$561.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$561.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.01
|
| Rate for Payer: Vantage Medical Group Senior |
$197.28
|
|
|
AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET [88365]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0088-1175-47
|
| Hospital Charge Code |
1710445
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET [88365]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 0088-1175-47
|
| Hospital Charge Code |
1710445
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
ALISKIREN 150 MG TABLET [78653]
|
Facility
OP
|
$11.63
|
|
|
Service Code
|
NDC 70839-150-30
|
| Hospital Charge Code |
1711903
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: BCBS Transplant Transplant |
$6.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Central Health Plan Commercial |
$9.30
|
| Rate for Payer: Cigna of CA HMO |
$8.14
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.65
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.72
|
| Rate for Payer: IEHP medi-cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.72
|
| Rate for Payer: Networks By Design Commercial |
$7.56
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: Riverside University Health MISP |
$4.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare HMO Rider |
$5.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
ALISKIREN 150 MG TABLET [78653]
|
Facility
IP
|
$11.63
|
|
|
Service Code
|
NDC 70839-150-30
|
| Hospital Charge Code |
1711903
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.21
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Central Health Plan Commercial |
$9.30
|
| Rate for Payer: Cigna of CA HMO |
$8.14
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.65
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.72
|
| Rate for Payer: Networks By Design Commercial |
$7.56
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$3,790.73
|
|
|
Service Code
|
APR-DRG 8111
|
| Min. Negotiated Rate |
$3,181.03 |
| Max. Negotiated Rate |
$3,790.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,181.03
|
| Rate for Payer: IEHP medi-cal |
$3,790.73
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$21,185.34
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$17,777.90 |
| Max. Negotiated Rate |
$21,185.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,777.90
|
| Rate for Payer: IEHP medi-cal |
$21,185.34
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$5,638.03
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$4,731.22 |
| Max. Negotiated Rate |
$5,638.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,731.22
|
| Rate for Payer: IEHP medi-cal |
$5,638.03
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$10,842.27
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$9,098.41 |
| Max. Negotiated Rate |
$10,842.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,098.41
|
| Rate for Payer: IEHP medi-cal |
$10,842.27
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$178,488.38
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$149,780.46 |
| Max. Negotiated Rate |
$178,488.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$149,780.46
|
| Rate for Payer: IEHP medi-cal |
$178,488.38
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$73,262.42
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$61,478.95 |
| Max. Negotiated Rate |
$73,262.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$61,478.95
|
| Rate for Payer: IEHP medi-cal |
$73,262.42
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$82,278.74
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$69,045.10 |
| Max. Negotiated Rate |
$82,278.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$69,045.10
|
| Rate for Payer: IEHP medi-cal |
$82,278.74
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$105,187.25
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$88,269.02 |
| Max. Negotiated Rate |
$105,187.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$88,269.02
|
| Rate for Payer: IEHP medi-cal |
$105,187.25
|
|
|
Allogenic Related Transplant
|
Facility
IP
|
$160,000.00
|
|
|
Service Code
|
MS-DRG 014
|
| Min. Negotiated Rate |
$160,000.00 |
| Max. Negotiated Rate |
$160,000.00 |
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$160,000.00
|
|
