|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
ERX219902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$280.30 |
| Rate for Payer: Blue Shield of California Commercial |
$233.58
|
| Rate for Payer: Blue Shield of California EPN |
$166.31
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
ERX219902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$280.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$189.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.00
|
| Rate for Payer: BCBS Transplant Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$195.90
|
| Rate for Payer: Blue Shield of California EPN |
$152.29
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$233.58
|
| Rate for Payer: IEHP medi-cal |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: Riverside University Health MISP |
$124.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
OP
|
$108.87
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
1712538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$97.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.32
|
| Rate for Payer: BCBS Transplant Transplant |
$65.32
|
| Rate for Payer: Blue Shield of California Commercial |
$68.48
|
| Rate for Payer: Blue Shield of California EPN |
$53.24
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Central Health Plan Commercial |
$87.10
|
| Rate for Payer: Cigna of CA HMO |
$76.21
|
| Rate for Payer: Cigna of CA PPO |
$76.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.55
|
| Rate for Payer: Galaxy Health WC |
$92.54
|
| Rate for Payer: Global Benefits Group Commercial |
$65.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$81.65
|
| Rate for Payer: IEHP medi-cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.77
|
| Rate for Payer: Multiplan Commercial |
$81.65
|
| Rate for Payer: Networks By Design Commercial |
$70.77
|
| Rate for Payer: Prime Health Services Commercial |
$92.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$65.32
|
| Rate for Payer: Riverside University Health MISP |
$43.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.44
|
| Rate for Payer: United Healthcare All Other HMO |
$54.44
|
| Rate for Payer: United Healthcare HMO Rider |
$54.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.54
|
| Rate for Payer: Vantage Medical Group Senior |
$92.54
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
IP
|
$108.87
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
1712538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$97.98 |
| Rate for Payer: Blue Shield of California Commercial |
$81.65
|
| Rate for Payer: Blue Shield of California EPN |
$58.14
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Central Health Plan Commercial |
$87.10
|
| Rate for Payer: Cigna of CA HMO |
$76.21
|
| Rate for Payer: Cigna of CA PPO |
$76.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: Galaxy Health WC |
$92.54
|
| Rate for Payer: Global Benefits Group Commercial |
$65.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.77
|
| Rate for Payer: Multiplan Commercial |
$81.65
|
| Rate for Payer: Networks By Design Commercial |
$70.77
|
| Rate for Payer: Prime Health Services Commercial |
$92.54
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.44 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.44 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency
|
Facility
OP
|
$27,132.55
|
|
|
Service Code
|
CPT 20982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,132.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,443.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,481.26
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$16,443.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26,968.11
|
| Rate for Payer: IEHP medi-cal |
$27,132.55
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Innovage PACE Commercial |
$24,665.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,034.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Multiplan WC |
$22,481.26
|
| Rate for Payer: Preferred Health Network WC |
$22,940.06
|
| Rate for Payer: Prime Health Services Medicare |
$17,430.61
|
| Rate for Payer: Prime Health Services WC |
$22,251.86
|
| Rate for Payer: Riverside University Health MISP |
$18,088.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
IP
|
$618.60
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX106761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.72 |
| Max. Negotiated Rate |
$556.74 |
| Rate for Payer: Blue Shield of California Commercial |
$463.95
|
| Rate for Payer: Blue Shield of California EPN |
$330.33
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Central Health Plan Commercial |
$494.88
|
| Rate for Payer: Cigna of CA HMO |
$433.02
|
| Rate for Payer: Cigna of CA PPO |
$433.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.44
|
| Rate for Payer: Galaxy Health WC |
$525.81
|
| Rate for Payer: Global Benefits Group Commercial |
$371.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.72
|
| Rate for Payer: Multiplan Commercial |
$463.95
|
| Rate for Payer: Networks By Design Commercial |
$309.30
|
| Rate for Payer: Prime Health Services Commercial |
$525.81
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
OP
|
$618.60
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX106761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$556.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.45
|
| Rate for Payer: BCBS Transplant Transplant |
$371.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Caremore Medicare Advantage |
$8.80
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Central Health Plan Commercial |
$494.88
|
| Rate for Payer: Cigna of CA HMO |
$433.02
|
| Rate for Payer: Cigna of CA PPO |
$433.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$525.81
|
| Rate for Payer: Global Benefits Group Commercial |
$371.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$463.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.44
|
| Rate for Payer: IEHP medi-cal |
$14.53
|
| Rate for Payer: IEHP Medicare Advantage |
$8.80
|
| Rate for Payer: Innovage PACE Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$463.95
|
| Rate for Payer: Networks By Design Commercial |
$309.30
|
| Rate for Payer: Prime Health Services Commercial |
$525.81
|
| Rate for Payer: Prime Health Services Medicare |
$9.33
|
| Rate for Payer: Riverside University Health MISP |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$371.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$309.30
|
| Rate for Payer: United Healthcare All Other HMO |
$309.30
|
| Rate for Payer: United Healthcare HMO Rider |
$309.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
IP
|
$1,030.80
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX99465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.16 |
| Max. Negotiated Rate |
$927.72 |
| Rate for Payer: Blue Shield of California Commercial |
$773.10
|
| Rate for Payer: Blue Shield of California EPN |
$550.45
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Central Health Plan Commercial |
$824.64
|
| Rate for Payer: Cigna of CA HMO |
$721.56
|
| Rate for Payer: Cigna of CA PPO |
$721.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$412.32
|
| Rate for Payer: Galaxy Health WC |
$876.18
|
| Rate for Payer: Global Benefits Group Commercial |
$618.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Multiplan Commercial |
$773.10
|
| Rate for Payer: Networks By Design Commercial |
$515.40
|
| Rate for Payer: Prime Health Services Commercial |
$876.18
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
OP
|
$1,030.80
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX99465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$927.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.45
|
| Rate for Payer: BCBS Transplant Transplant |
$618.48
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Caremore Medicare Advantage |
$8.80
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Central Health Plan Commercial |
$824.64
|
| Rate for Payer: Cigna of CA HMO |
$721.56
|
| Rate for Payer: Cigna of CA PPO |
$721.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$876.18
|
| Rate for Payer: Global Benefits Group Commercial |
$618.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$773.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.44
|
| Rate for Payer: IEHP medi-cal |
$14.53
|
| Rate for Payer: IEHP Medicare Advantage |
$8.80
|
| Rate for Payer: Innovage PACE Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$773.10
|
| Rate for Payer: Networks By Design Commercial |
$515.40
|
| Rate for Payer: Prime Health Services Commercial |
$876.18
|
| Rate for Payer: Prime Health Services Medicare |
$9.33
|
| Rate for Payer: Riverside University Health MISP |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.40
|
| Rate for Payer: United Healthcare All Other HMO |
$515.40
|
| Rate for Payer: United Healthcare HMO Rider |
$515.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$515.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$29,947.66
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$25,130.90 |
| Max. Negotiated Rate |
$29,947.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,130.90
|
| Rate for Payer: IEHP medi-cal |
$29,947.66
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$5,603.33
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$4,702.09 |
| Max. Negotiated Rate |
$5,603.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,702.09
|
| Rate for Payer: IEHP medi-cal |
$5,603.33
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$7,417.27
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$6,224.28 |
| Max. Negotiated Rate |
$7,417.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,224.28
|
| Rate for Payer: IEHP medi-cal |
$7,417.27
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$10,029.41
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$8,416.28 |
| Max. Negotiated Rate |
$10,029.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,416.28
|
| Rate for Payer: IEHP medi-cal |
$10,029.41
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$4,786.45
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$4,016.60 |
| Max. Negotiated Rate |
$4,786.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,016.60
|
| Rate for Payer: IEHP medi-cal |
$4,786.45
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$19,336.70
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$16,226.60 |
| Max. Negotiated Rate |
$19,336.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,226.60
|
| Rate for Payer: IEHP medi-cal |
$19,336.70
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$3,578.50
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$3,002.94 |
| Max. Negotiated Rate |
$3,578.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,002.94
|
| Rate for Payer: IEHP medi-cal |
$3,578.50
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$6,681.82
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$5,607.12 |
| Max. Negotiated Rate |
$6,681.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,607.12
|
| Rate for Payer: IEHP medi-cal |
$6,681.82
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
1711694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
1711694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
OP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Riverside University Health MISP |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
1753544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
IP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
1753544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
