|
Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Correction of lid retraction
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67911
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 67825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.98 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$590.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: IEHP medi-cal |
$600.57
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Innovage PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Prime Health Services Medicare |
$385.82
|
| Rate for Payer: Riverside University Health MISP |
$400.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
IP
|
$8,168.16
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,633.63 |
| Max. Negotiated Rate |
$7,351.34 |
| Rate for Payer: Blue Shield of California Commercial |
$6,126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,686.54
|
| Rate for Payer: Blue Shield of California EPN |
$5,472.82
|
| Rate for Payer: Blue Shield of California EPN |
$4,361.80
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Central Health Plan Commercial |
$8,198.98
|
| Rate for Payer: Central Health Plan Commercial |
$6,534.53
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,099.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,267.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,099.49
|
| Rate for Payer: Galaxy Health WC |
$8,711.41
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$6,149.23
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,351.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,223.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.74
|
| Rate for Payer: Multiplan Commercial |
$6,126.12
|
| Rate for Payer: Multiplan Commercial |
$7,686.54
|
| Rate for Payer: Networks By Design Commercial |
$5,124.36
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Prime Health Services Commercial |
$8,711.41
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
OP
|
$8,168.16
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,633.63 |
| Max. Negotiated Rate |
$25,378.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,095.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,095.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25,378.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25,378.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,955.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,962.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,054.94
|
| Rate for Payer: BCBS Transplant Transplant |
$4,900.90
|
| Rate for Payer: BCBS Transplant Transplant |
$6,149.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,137.77
|
| Rate for Payer: Blue Shield of California Commercial |
$6,446.44
|
| Rate for Payer: Blue Shield of California EPN |
$5,011.62
|
| Rate for Payer: Blue Shield of California EPN |
$3,994.23
|
| Rate for Payer: Caremore Medicare Advantage |
$4,095.32
|
| Rate for Payer: Caremore Medicare Advantage |
$4,095.32
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Central Health Plan Commercial |
$6,534.53
|
| Rate for Payer: Central Health Plan Commercial |
$8,198.98
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,174.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,528.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,528.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,095.32
|
| Rate for Payer: Galaxy Health WC |
$8,711.41
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,149.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,223.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,351.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,126.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,686.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,716.32
|
| Rate for Payer: IEHP medi-cal |
$6,757.27
|
| Rate for Payer: IEHP medi-cal |
$6,757.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,095.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,095.32
|
| Rate for Payer: Innovage PACE Commercial |
$6,142.98
|
| Rate for Payer: Innovage PACE Commercial |
$6,142.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,448.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,095.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,487.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,487.73
|
| Rate for Payer: Multiplan Commercial |
$7,686.54
|
| Rate for Payer: Multiplan Commercial |
$6,126.12
|
| Rate for Payer: Networks By Design Commercial |
$5,124.36
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Prime Health Services Commercial |
$8,711.41
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Prime Health Services Medicare |
$4,341.04
|
| Rate for Payer: Prime Health Services Medicare |
$4,341.04
|
| Rate for Payer: Riverside University Health MISP |
$4,504.85
|
| Rate for Payer: Riverside University Health MISP |
$4,504.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,900.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,149.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,149.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,900.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,084.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,124.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5,124.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,084.08
|
| Rate for Payer: United Healthcare HMO Rider |
$5,124.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,084.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,084.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,124.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
IP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California EPN |
$51.39
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Central Health Plan Commercial |
$76.99
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$72.18
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
OP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$230.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$168.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.90
|
| Rate for Payer: BCBS Transplant Transplant |
$57.74
|
| Rate for Payer: Blue Shield of California Commercial |
$116.39
|
| Rate for Payer: Blue Shield of California EPN |
$105.81
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Central Health Plan Commercial |
$76.99
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.18
|
| Rate for Payer: IEHP medi-cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$72.18
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Riverside University Health MISP |
$38.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.12
|
| Rate for Payer: United Healthcare All Other HMO |
$48.12
|
| Rate for Payer: United Healthcare HMO Rider |
$48.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
IP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Blue Shield of California Commercial |
$230.40
|
| Rate for Payer: Blue Shield of California EPN |
$164.04
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Central Health Plan Commercial |
$245.76
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$215.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.88
|
| Rate for Payer: Galaxy Health WC |
$261.12
|
| Rate for Payer: Global Benefits Group Commercial |
$184.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$276.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.44
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$153.60
|
| Rate for Payer: Prime Health Services Commercial |
$261.12
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
OP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.44 |
| Max. Negotiated Rate |
$895.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$895.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$261.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$148.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.49
|
| Rate for Payer: BCBS Transplant Transplant |
$184.32
|
| Rate for Payer: Blue Shield of California Commercial |
$193.23
|
| Rate for Payer: Blue Shield of California EPN |
$150.22
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Central Health Plan Commercial |
$245.76
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$215.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.88
|
| Rate for Payer: Galaxy Health WC |
$261.12
|
| Rate for Payer: Global Benefits Group Commercial |
$184.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$276.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$230.40
|
| Rate for Payer: IEHP medi-cal |
$145.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.44
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$153.60
|
| Rate for Payer: Prime Health Services Commercial |
$261.12
|
| Rate for Payer: Riverside University Health MISP |
$122.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Other HMO |
$153.60
|
| Rate for Payer: United Healthcare HMO Rider |
$153.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.12
|
| Rate for Payer: Vantage Medical Group Senior |
$261.12
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$36,071.95
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$30,270.17 |
| Max. Negotiated Rate |
$36,071.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,270.17
|
| Rate for Payer: IEHP medi-cal |
$36,071.95
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$77,966.12
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$65,426.11 |
| Max. Negotiated Rate |
$77,966.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$65,426.11
|
| Rate for Payer: IEHP medi-cal |
$77,966.12
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$46,456.40
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$38,984.39 |
| Max. Negotiated Rate |
$46,456.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,984.39
|
| Rate for Payer: IEHP medi-cal |
$46,456.40
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$41,264.17
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$34,627.27 |
| Max. Negotiated Rate |
$41,264.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,627.27
|
| Rate for Payer: IEHP medi-cal |
$41,264.17
|
|
|
Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)
|
Facility
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 61790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,412.38 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: IEHP medi-cal |
$3,980.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Innovage PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health MISP |
$2,653.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
IP
|
$294.35
|
|
|
Service Code
|
NDC 0078-0883-61
|
| Hospital Charge Code |
NDG225907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$264.92 |
| Rate for Payer: Blue Shield of California Commercial |
$220.76
|
| Rate for Payer: Blue Shield of California EPN |
$157.18
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Central Health Plan Commercial |
$235.48
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.87
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
OP
|
$294.35
|
|
|
Service Code
|
NDC 0078-0883-61
|
| Hospital Charge Code |
NDG225907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$264.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$178.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$250.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.90
|
| Rate for Payer: BCBS Transplant Transplant |
$176.61
|
| Rate for Payer: Blue Shield of California Commercial |
$185.15
|
| Rate for Payer: Blue Shield of California EPN |
$143.94
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Central Health Plan Commercial |
$235.48
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$220.76
|
| Rate for Payer: IEHP medi-cal |
$103.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.87
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: Riverside University Health MISP |
$117.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.18
|
| Rate for Payer: United Healthcare All Other HMO |
$147.18
|
| Rate for Payer: United Healthcare HMO Rider |
$147.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.20
|
| Rate for Payer: Vantage Medical Group Senior |
$250.20
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
OP
|
$423.16
|
|
|
Service Code
|
NDC 0069-8140-20
|
| Hospital Charge Code |
1712554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$380.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$256.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$359.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$232.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.00
|
| Rate for Payer: BCBS Transplant Transplant |
$253.90
|
| Rate for Payer: Blue Shield of California Commercial |
$266.17
|
| Rate for Payer: Blue Shield of California EPN |
$206.93
|
| Rate for Payer: Cash Price |
$190.42
|
| Rate for Payer: Central Health Plan Commercial |
$338.53
|
| Rate for Payer: Cigna of CA HMO |
$296.21
|
| Rate for Payer: Cigna of CA PPO |
$296.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.26
|
| Rate for Payer: Galaxy Health WC |
$359.69
|
| Rate for Payer: Global Benefits Group Commercial |
$253.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$317.37
|
| Rate for Payer: IEHP medi-cal |
$148.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.63
|
| Rate for Payer: Multiplan Commercial |
$317.37
|
| Rate for Payer: Networks By Design Commercial |
$275.05
|
| Rate for Payer: Prime Health Services Commercial |
$359.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$253.90
|
| Rate for Payer: Riverside University Health MISP |
$169.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.58
|
| Rate for Payer: United Healthcare All Other HMO |
$211.58
|
| Rate for Payer: United Healthcare HMO Rider |
$211.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.69
|
| Rate for Payer: Vantage Medical Group Senior |
$359.69
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
IP
|
$423.16
|
|
|
Service Code
|
NDC 0069-8140-20
|
| Hospital Charge Code |
1712554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$380.84 |
| Rate for Payer: Blue Shield of California Commercial |
$317.37
|
| Rate for Payer: Blue Shield of California EPN |
$225.97
|
| Rate for Payer: Cash Price |
$190.42
|
| Rate for Payer: Central Health Plan Commercial |
$338.53
|
| Rate for Payer: Cigna of CA HMO |
$296.21
|
| Rate for Payer: Cigna of CA PPO |
$296.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.26
|
| Rate for Payer: Galaxy Health WC |
$359.69
|
| Rate for Payer: Global Benefits Group Commercial |
$253.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.63
|
| Rate for Payer: Multiplan Commercial |
$317.37
|
| Rate for Payer: Networks By Design Commercial |
$275.05
|
| Rate for Payer: Prime Health Services Commercial |
$359.69
|
|
|
CROMOLYN 20 MG/2 ML SOLUTION FOR NEBULIZATION [9690]
|
Facility
OP
|
$10.85
|
|
|
Service Code
|
NDC 69784-205-60
|
| Hospital Charge Code |
1781097
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.41
|
| Rate for Payer: BCBS Transplant Transplant |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$5.31
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Central Health Plan Commercial |
$8.68
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.14
|
| Rate for Payer: IEHP medi-cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$8.14
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: Riverside University Health MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO |
$5.42
|
| Rate for Payer: United Healthcare HMO Rider |
$5.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
CROMOLYN 20 MG/2 ML SOLUTION FOR NEBULIZATION [9690]
|
Facility
IP
|
$10.85
|
|
|
Service Code
|
NDC 69784-205-60
|
| Hospital Charge Code |
1781097
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Blue Shield of California Commercial |
$8.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Central Health Plan Commercial |
$8.68
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$8.14
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
IP
|
$2.70
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
OP
|
$2.70
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.02
|
| Rate for Payer: IEHP medi-cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: Riverside University Health MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 17478-291-11
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$1.92
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$2.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$2.33
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
OP
|
$2.74
|
|
|
Service Code
|
NDC 17478-291-11
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.62
|
| Rate for Payer: BCBS Transplant Transplant |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$1.92
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$2.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.06
|
| Rate for Payer: IEHP medi-cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$2.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: Riverside University Health MISP |
$1.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: Vantage Medical Group Senior |
$2.33
|
|
