|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
OP
|
$125.67
|
|
|
Service Code
|
NDC 5789415012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$25.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.10
|
| Rate for Payer: Blue Shield of California Commercial |
$79.67
|
| Rate for Payer: Blue Shield of California EPN |
$50.14
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Central Health Plan Commercial |
$100.54
|
| Rate for Payer: Cigna of CA HMO |
$87.97
|
| Rate for Payer: Cigna of CA PPO |
$87.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.27
|
| Rate for Payer: EPIC Health Plan Senior |
$50.27
|
| Rate for Payer: Galaxy Health WC |
$106.82
|
| Rate for Payer: Global Benefits Group Commercial |
$75.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.97
|
| Rate for Payer: Multiplan Commercial |
$94.25
|
| Rate for Payer: Networks By Design Commercial |
$81.69
|
| Rate for Payer: Prime Health Services Commercial |
$106.82
|
| Rate for Payer: Riverside University Health System MISP |
$50.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.84
|
| Rate for Payer: United Healthcare All Other HMO |
$62.84
|
| Rate for Payer: United Healthcare HMO Rider |
$62.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.82
|
| Rate for Payer: Vantage Medical Group Senior |
$106.82
|
|
|
ABLATION OF MALIGNANT PROSTATE TISSUE, TRANSRECTAL, WITH HIGH INTENSITY-FOCUSED ULTRASOUND (HIFU), INCLUDING ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 55880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,440.81 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Multiplan WC |
$18,720.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$12,175.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,393.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,175.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,720.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,175.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,089.49
|
| Rate for Payer: EPIC Health Plan Senior |
$13,393.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19,967.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,440.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,175.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,591.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,045.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,315.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,175.45
|
| Rate for Payer: Preferred Health Network WC |
$19,102.66
|
| Rate for Payer: Prime Health Services Medicare |
$12,905.98
|
| Rate for Payer: Prime Health Services WC |
$18,529.58
|
| Rate for Payer: Riverside University Health System MISP |
$13,393.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12,175.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,175.45
|
|
|
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
|
$37,209.84
|
|
|
Service Code
|
CPT 20982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$37,209.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,551.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,209.84
|
| Rate for Payer: EPIC Health Plan Senior |
$24,806.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,984.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,326.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,988.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,571.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Medicare |
$23,904.51
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$24,806.56
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,551.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
OP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$570.78 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.61
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$285.39
|
| Rate for Payer: Cash Price |
$285.39
|
| Rate for Payer: Central Health Plan Commercial |
$507.36
|
| Rate for Payer: Cigna of CA HMO |
$443.94
|
| Rate for Payer: Cigna of CA PPO |
$443.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.77
|
| Rate for Payer: EPIC Health Plan Senior |
$9.85
|
| Rate for Payer: Galaxy Health WC |
$539.07
|
| Rate for Payer: Global Benefits Group Commercial |
$380.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$475.65
|
| Rate for Payer: Networks By Design Commercial |
$317.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.95
|
| Rate for Payer: Prime Health Services Commercial |
$539.07
|
| Rate for Payer: Prime Health Services Medicare |
$9.49
|
| Rate for Payer: Riverside University Health System MISP |
$9.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.02
|
| Rate for Payer: United Healthcare All Other HMO |
$231.67
|
| Rate for Payer: United Healthcare HMO Rider |
$226.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.85
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
IP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$570.78 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Blue Shield of California Commercial |
$508.63
|
| Rate for Payer: Blue Shield of California EPN |
$319.64
|
| Rate for Payer: Cash Price |
$285.39
|
| Rate for Payer: Central Health Plan Commercial |
$507.36
|
| Rate for Payer: Cigna of CA HMO |
$443.94
|
| Rate for Payer: Cigna of CA PPO |
$443.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.68
|
| Rate for Payer: EPIC Health Plan Senior |
$253.68
|
| Rate for Payer: Galaxy Health WC |
$539.07
|
| Rate for Payer: Global Benefits Group Commercial |
$380.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.84
|
| Rate for Payer: Multiplan Commercial |
$475.65
|
| Rate for Payer: Networks By Design Commercial |
$317.10
|
| Rate for Payer: Prime Health Services Commercial |
$539.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.02
|
| Rate for Payer: United Healthcare All Other HMO |
$231.67
|
| Rate for Payer: United Healthcare HMO Rider |
$226.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.70
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
|
OP
|
$1,056.60
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$950.94 |
| Rate for Payer: Adventist Health Commercial |
$211.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.61
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$475.47
|
| Rate for Payer: Cash Price |
$475.47
|
| Rate for Payer: Central Health Plan Commercial |
$845.28
|
| Rate for Payer: Cigna of CA HMO |
$739.62
|
| Rate for Payer: Cigna of CA PPO |
$739.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.77
|
| Rate for Payer: EPIC Health Plan Senior |
$9.85
|
| Rate for Payer: Galaxy Health WC |
$898.11
|
| Rate for Payer: Global Benefits Group Commercial |
$633.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$792.45
|
| Rate for Payer: Networks By Design Commercial |
$528.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.95
|
| Rate for Payer: Prime Health Services Commercial |
$898.11
|
| Rate for Payer: Prime Health Services Medicare |
$9.49
|
| Rate for Payer: Riverside University Health System MISP |
$9.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.54
|
| Rate for Payer: United Healthcare All Other HMO |
$385.98
|
| Rate for Payer: United Healthcare HMO Rider |
$377.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.85
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
|
IP
|
$1,056.60
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.32 |
| Max. Negotiated Rate |
$950.94 |
| Rate for Payer: Adventist Health Commercial |
$211.32
|
| Rate for Payer: Blue Shield of California Commercial |
$847.39
|
| Rate for Payer: Blue Shield of California EPN |
$532.53
|
| Rate for Payer: Cash Price |
$475.47
|
| Rate for Payer: Central Health Plan Commercial |
$845.28
|
| Rate for Payer: Cigna of CA HMO |
$739.62
|
| Rate for Payer: Cigna of CA PPO |
$739.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.64
|
| Rate for Payer: EPIC Health Plan Senior |
$422.64
|
| Rate for Payer: Galaxy Health WC |
$898.11
|
| Rate for Payer: Global Benefits Group Commercial |
$633.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.32
|
| Rate for Payer: Multiplan Commercial |
$792.45
|
| Rate for Payer: Networks By Design Commercial |
$528.30
|
| Rate for Payer: Prime Health Services Commercial |
$898.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.54
|
| Rate for Payer: United Healthcare All Other HMO |
$385.98
|
| Rate for Payer: United Healthcare HMO Rider |
$377.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.04
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$26,390.06
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$26,390.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,390.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,046.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,866.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,305.95
|
| Rate for Payer: EPIC Health Plan Senior |
$16,203.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,730.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,623.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,739.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,730.88
|
| Rate for Payer: Prime Health Services Medicare |
$15,614.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$11,352.78
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$7,170.18 |
| Max. Negotiated Rate |
$11,352.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,170.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,544.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,352.78
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$33,572.71
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$21,203.82 |
| Max. Negotiated Rate |
$33,572.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,203.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,267.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,572.71
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$8,625.37
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$5,447.60 |
| Max. Negotiated Rate |
$8,625.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,447.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,491.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,625.37
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$18,376.27
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$11,606.06 |
| Max. Negotiated Rate |
$18,376.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,606.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,830.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,376.27
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$20,632.99
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$20,632.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,768.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,123.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,973.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,632.99
|
| Rate for Payer: EPIC Health Plan Senior |
$13,755.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,504.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,506.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,756.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,504.84
|
| Rate for Payer: Prime Health Services Medicare |
$13,255.13
|
| 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
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$27,341.82
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$17,268.52 |
| Max. Negotiated Rate |
$27,341.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,268.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,578.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,341.82
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$12,165.91
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$7,683.73 |
| Max. Negotiated Rate |
$12,165.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,683.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,156.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,165.91
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$5,554.54
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$3,508.13 |
| Max. Negotiated Rate |
$5,554.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,508.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,180.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,554.54
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$7,116.55
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$4,494.66 |
| Max. Negotiated Rate |
$7,116.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,494.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,356.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,116.55
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 0904721304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 5107924106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 6846243518
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 6945235325
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 0904721304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Riverside University Health System MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 5107924106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 6846243518
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
|
|
ACAMPROSATE 333 MG TABLET,DELAYED RELEASE [39720]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 0378633380
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Riverside University Health System MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
