|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
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
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION [29313]
|
Facility
OP
|
$3,837.60
|
|
|
Service Code
|
CPT J0840
|
| Hospital Charge Code |
1759986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.52 |
| Max. Negotiated Rate |
$12,083.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,949.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,083.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,437.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,144.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,144.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,022.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,404.31
|
| Rate for Payer: BCBS Transplant Transplant |
$2,302.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,221.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,837.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,949.92
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Central Health Plan Commercial |
$3,070.08
|
| Rate for Payer: Cigna of CA HMO |
$2,686.32
|
| Rate for Payer: Cigna of CA PPO |
$2,686.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,924.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,949.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,949.92
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,453.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,878.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,197.86
|
| Rate for Payer: IEHP medi-cal |
$3,217.36
|
| Rate for Payer: IEHP Medicare Advantage |
$1,949.92
|
| Rate for Payer: Innovage PACE Commercial |
$2,924.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,559.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,949.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,612.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,612.89
|
| Rate for Payer: Multiplan Commercial |
$2,878.20
|
| Rate for Payer: Networks By Design Commercial |
$1,918.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,261.96
|
| Rate for Payer: Prime Health Services Medicare |
$2,066.91
|
| Rate for Payer: Riverside University Health MISP |
$2,144.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,302.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,302.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,918.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,918.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1,918.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,918.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,924.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,144.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1,949.92
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION [29313]
|
Facility
IP
|
$3,837.60
|
|
|
Service Code
|
CPT J0840
|
| Hospital Charge Code |
1759986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,049.28
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Central Health Plan Commercial |
$3,070.08
|
| Rate for Payer: Cigna of CA HMO |
$2,686.32
|
| Rate for Payer: Cigna of CA PPO |
$2,686.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,535.04
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,453.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,559.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Multiplan Commercial |
$2,878.20
|
| Rate for Payer: Networks By Design Commercial |
$1,918.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,261.96
|
|
|
Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)
|
Facility
OP
|
$48,045.00
|
|
|
Service Code
|
CPT 55873
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,405.00 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,510.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,265.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,661.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,510.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,736.05
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$11,510.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,265.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,538.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,510.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,510.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18,876.68
|
| Rate for Payer: IEHP medi-cal |
$18,991.78
|
| Rate for Payer: IEHP Medicare Advantage |
$11,510.17
|
| Rate for Payer: Innovage PACE Commercial |
$17,265.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,510.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,423.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,423.63
|
| Rate for Payer: Multiplan WC |
$15,736.05
|
| Rate for Payer: Preferred Health Network WC |
$16,057.19
|
| Rate for Payer: Prime Health Services Medicare |
$12,200.78
|
| Rate for Payer: Prime Health Services WC |
$15,575.47
|
| Rate for Payer: Riverside University Health MISP |
$12,661.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,265.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,661.19
|
| Rate for Payer: Vantage Medical Group Senior |
$11,510.17
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
IP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-01
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
IP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-11
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
OP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
ERX110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.95
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Riverside University Health MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
OP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-11
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.36
|
| Rate for Payer: IEHP medi-cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Riverside University Health MISP |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
OP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-01
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.36
|
| Rate for Payer: IEHP medi-cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Riverside University Health MISP |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
IP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
ERX110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$19,278.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,278.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$22,973.92
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$12,824.92 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,824.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,283.02
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$9,581.16 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,581.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$11,417.55
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$7,745.35 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,745.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$9,229.88
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
NDC 10122-313-10
|
| Hospital Charge Code |
1771308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 10122-313-10
|
| Hospital Charge Code |
1771308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
CVL-NITROGLYCERIN 50MG/500ML NS FOR IA/IC BOLUS [4080932]
|
Facility
IP
|
$8.75
|
|
|
Service Code
|
NDC 9994-0809-32
|
| Hospital Charge Code |
NDG4080932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Central Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.44
|
| Rate for Payer: Global Benefits Group Commercial |
$5.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.56
|
| Rate for Payer: Networks By Design Commercial |
$5.69
|
| Rate for Payer: Prime Health Services Commercial |
$7.44
|
|
|
CVL-NITROGLYCERIN 50MG/500ML NS FOR IA/IC BOLUS [4080932]
|
Facility
OP
|
$8.75
|
|
|
Service Code
|
NDC 9994-0809-32
|
| Hospital Charge Code |
NDG4080932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.17
|
| Rate for Payer: BCBS Transplant Transplant |
$5.25
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Central Health Plan Commercial |
$7.00
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.44
|
| Rate for Payer: Global Benefits Group Commercial |
$5.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.56
|
| Rate for Payer: IEHP medi-cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.56
|
| Rate for Payer: Networks By Design Commercial |
$5.69
|
| Rate for Payer: Prime Health Services Commercial |
$7.44
|
| Rate for Payer: Riverside University Health MISP |
$3.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.44
|
| Rate for Payer: Vantage Medical Group Senior |
$7.44
|
|
