|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 8770140733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 5026834615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5026834615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 8770140733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5026834611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$3.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Central Health Plan Commercial |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$6.12
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$6.55
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$7.43
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Riverside University Health System MISP |
$3.50
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$7.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]
|
Facility
|
IP
|
$8.74
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Central Health Plan Commercial |
$6.99
|
| Rate for Payer: Cigna of CA HMO |
$6.12
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$6.12
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$7.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$6.55
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$7.43
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 9994080276
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 9994080276
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$16.68
|
| Rate for Payer: Blue Shield of California Commercial |
$16.68
|
| Rate for Payer: Blue Shield of California EPN |
$15.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.16
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Central Health Plan Commercial |
$630.40
|
| Rate for Payer: Central Health Plan Commercial |
$960.00
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA HMO |
$840.00
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: Networks By Design Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Prime Health Services Medicare |
$6.55
|
| Rate for Payer: Prime Health Services Medicare |
$6.55
|
| Rate for Payer: Riverside University Health System MISP |
$6.80
|
| Rate for Payer: Riverside University Health System MISP |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$438.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare HMO Rider |
$428.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$631.98
|
| Rate for Payer: Blue Shield of California Commercial |
$962.40
|
| Rate for Payer: Blue Shield of California EPN |
$604.80
|
| Rate for Payer: Blue Shield of California EPN |
$397.15
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Central Health Plan Commercial |
$630.40
|
| Rate for Payer: Central Health Plan Commercial |
$960.00
|
| Rate for Payer: Cigna of CA HMO |
$840.00
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$840.00
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$315.20
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: Networks By Design Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare All Other HMO |
$438.36
|
| Rate for Payer: United Healthcare HMO Rider |
$428.88
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
OP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Central Health Plan Commercial |
$69.72
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.01
|
| Rate for Payer: Multiplan Commercial |
$65.36
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: Riverside University Health System MISP |
$34.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.08
|
| Rate for Payer: Vantage Medical Group Senior |
$74.08
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
IP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California Commercial |
$69.89
|
| Rate for Payer: Blue Shield of California EPN |
$43.92
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Central Health Plan Commercial |
$69.72
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$65.36
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
IP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$53.69 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Blue Shield of California Commercial |
$47.85
|
| Rate for Payer: Blue Shield of California EPN |
$30.07
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Central Health Plan Commercial |
$47.73
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$44.74
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
OP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$53.69 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Central Health Plan Commercial |
$47.73
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$44.74
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.71
|
| Rate for Payer: Vantage Medical Group Senior |
$50.71
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
OP
|
$108.64
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$97.78 |
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Central Health Plan Commercial |
$88.48
|
| Rate for Payer: Central Health Plan Commercial |
$86.91
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$81.48
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: Riverside University Health System MISP |
$43.46
|
| Rate for Payer: Riverside University Health System MISP |
$44.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Blue Shield of California Commercial |
$88.70
|
| Rate for Payer: Blue Shield of California Commercial |
$87.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.75
|
| Rate for Payer: Blue Shield of California EPN |
$55.74
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Central Health Plan Commercial |
$88.48
|
| Rate for Payer: Central Health Plan Commercial |
$86.91
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.73
|
| Rate for Payer: Multiplan Commercial |
$81.48
|
| Rate for Payer: Multiplan Commercial |
$82.95
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$29,113.11
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$18,387.23 |
| Max. Negotiated Rate |
$29,113.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,387.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,911.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,113.11
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$20,135.86
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$12,717.38 |
| Max. Negotiated Rate |
$20,135.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,717.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,154.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,135.86
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$48,942.80
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$30,911.24 |
| Max. Negotiated Rate |
$48,942.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,911.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,835.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48,942.80
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$15,384.38
|
|
|
Service Code
|
APR-DRG 3141
|
| Min. Negotiated Rate |
$9,716.45 |
| Max. Negotiated Rate |
$15,384.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,716.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,578.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,384.38
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$49,195.47
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$49,195.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,195.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31,778.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44,490.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,024.81
|
| Rate for Payer: EPIC Health Plan Senior |
$29,349.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,681.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,354.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,753.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26,681.70
|
| Rate for Payer: Prime Health Services Medicare |
$28,282.60
|
| 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
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,458.96
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$73,458.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73,458.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47,451.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,433.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$65,004.36
|
| Rate for Payer: EPIC Health Plan Senior |
$43,336.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,396.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,155.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52,791.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39,396.58
|
| Rate for Payer: Prime Health Services Medicare |
$41,760.37
|
| 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
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,184.70
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$47,184.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,184.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,479.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,672.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,286.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28,190.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,627.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,879.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,341.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,627.99
|
| Rate for Payer: Prime Health Services Medicare |
$27,165.67
|
| 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
|
|
|
FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIAN FOREHEAD FLAP)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15731
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,541.98 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,557.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| 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 |
$7,411.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,541.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,703.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,380.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$7,562.79
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$7,335.91
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
