|
DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT J0894
|
| Hospital Charge Code |
1755761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Blue Shield of California Commercial |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$384.48
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$126.88
|
| Rate for Payer: Blue Shield of California EPN |
$128.16
|
| Rate for Payer: Cash Price |
$106.92
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$190.08
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$166.32
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$166.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$95.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$288.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$201.96
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Global Benefits Group Commercial |
$142.56
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$178.20
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$118.80
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$201.96
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.62
|
| Rate for Payer: United Healthcare All Other HMO |
$265.54
|
| Rate for Payer: United Healthcare All Other HMO |
$44.26
|
| Rate for Payer: United Healthcare All Other HMO |
$88.51
|
| Rate for Payer: United Healthcare All Other HMO |
$87.63
|
| Rate for Payer: United Healthcare HMO Rider |
$86.59
|
| Rate for Payer: United Healthcare HMO Rider |
$85.73
|
| Rate for Payer: United Healthcare HMO Rider |
$43.30
|
| Rate for Payer: United Healthcare HMO Rider |
$259.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.60
|
|
|
Decompressive fasciotomy, hand (excludes 26035)
|
Facility
|
OP
|
$10,567.00
|
|
|
Service Code
|
CPT 26037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.95 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| 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 |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
DEFERASIROX 180 MG TABLET [206427]
|
Facility
|
IP
|
$116.95
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
ERX206427
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Blue Shield of California Commercial |
$87.71
|
| Rate for Payer: Blue Shield of California EPN |
$62.45
|
| Rate for Payer: Cash Price |
$52.63
|
| Rate for Payer: Central Health Plan Commercial |
$93.56
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.41
|
| Rate for Payer: Global Benefits Group Commercial |
$70.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$87.71
|
| Rate for Payer: Networks By Design Commercial |
$76.02
|
| Rate for Payer: Prime Health Services Commercial |
$99.41
|
|
|
DEFERASIROX 180 MG TABLET [206427]
|
Facility
|
OP
|
$116.95
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
ERX206427
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: Blue Distinction Transplant |
$70.17
|
| Rate for Payer: Blue Shield of California Commercial |
$73.56
|
| Rate for Payer: Blue Shield of California EPN |
$57.19
|
| Rate for Payer: Cash Price |
$52.63
|
| Rate for Payer: Central Health Plan Commercial |
$93.56
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.41
|
| Rate for Payer: Dignity Health Media |
$99.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.41
|
| Rate for Payer: Global Benefits Group Commercial |
$70.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$87.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$87.71
|
| Rate for Payer: Networks By Design Commercial |
$76.02
|
| Rate for Payer: Prime Health Services Commercial |
$99.41
|
| Rate for Payer: Riverside University Health System MISP |
$46.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.48
|
| Rate for Payer: United Healthcare All Other HMO |
$58.48
|
| Rate for Payer: United Healthcare HMO Rider |
$58.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.41
|
| Rate for Payer: Vantage Medical Group Senior |
$99.41
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
IP
|
$116.95
|
|
|
Service Code
|
NDC 0078-0469-15
|
| Hospital Charge Code |
1712350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Blue Shield of California Commercial |
$87.71
|
| Rate for Payer: Blue Shield of California EPN |
$62.45
|
| Rate for Payer: Cash Price |
$52.63
|
| Rate for Payer: Central Health Plan Commercial |
$93.56
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.41
|
| Rate for Payer: Global Benefits Group Commercial |
$70.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$87.71
|
| Rate for Payer: Networks By Design Commercial |
$76.02
|
| Rate for Payer: Prime Health Services Commercial |
$99.41
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
OP
|
$116.95
|
|
|
Service Code
|
NDC 0078-0469-15
|
| Hospital Charge Code |
1712350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: Blue Distinction Transplant |
$70.17
|
| Rate for Payer: Blue Shield of California Commercial |
$73.56
|
| Rate for Payer: Blue Shield of California EPN |
$57.19
|
| Rate for Payer: Cash Price |
$52.63
|
| Rate for Payer: Central Health Plan Commercial |
$93.56
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.41
|
| Rate for Payer: Dignity Health Media |
$99.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.41
|
| Rate for Payer: Global Benefits Group Commercial |
$70.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$87.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$87.71
|
| Rate for Payer: Networks By Design Commercial |
$76.02
|
| Rate for Payer: Prime Health Services Commercial |
$99.41
|
| Rate for Payer: Riverside University Health System MISP |
$46.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.48
|
| Rate for Payer: United Healthcare All Other HMO |
$58.48
|
| Rate for Payer: United Healthcare HMO Rider |
$58.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.41
|
| Rate for Payer: Vantage Medical Group Senior |
$99.41
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
OP
|
$60.08
|
|
|
Service Code
|
NDC 45963-455-30
|
| Hospital Charge Code |
1712350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.50
|
| Rate for Payer: Blue Distinction Transplant |
$36.05
|
| Rate for Payer: Blue Shield of California Commercial |
$37.79
|
| Rate for Payer: Blue Shield of California EPN |
$29.38
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Central Health Plan Commercial |
$48.06
|
| Rate for Payer: Cigna of CA HMO |
$42.06
|
| Rate for Payer: Cigna of CA PPO |
$42.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.07
|
| Rate for Payer: Dignity Health Media |
$51.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.03
|
| Rate for Payer: Galaxy Health WC |
$51.07
|
| Rate for Payer: Global Benefits Group Commercial |
$36.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.02
|
| Rate for Payer: Multiplan Commercial |
$45.06
|
| Rate for Payer: Networks By Design Commercial |
$39.05
|
| Rate for Payer: Prime Health Services Commercial |
$51.07
|
| Rate for Payer: Riverside University Health System MISP |
$24.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.04
|
| Rate for Payer: United Healthcare All Other HMO |
$30.04
|
| Rate for Payer: United Healthcare HMO Rider |
$30.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.07
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
IP
|
$60.08
|
|
|
Service Code
|
NDC 45963-455-30
|
| Hospital Charge Code |
1712350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Blue Shield of California Commercial |
$45.06
|
| Rate for Payer: Blue Shield of California EPN |
$32.08
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Central Health Plan Commercial |
$48.06
|
| Rate for Payer: Cigna of CA HMO |
$42.06
|
| Rate for Payer: Cigna of CA PPO |
$42.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.03
|
| Rate for Payer: Galaxy Health WC |
$51.07
|
| Rate for Payer: Global Benefits Group Commercial |
$36.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.02
|
| Rate for Payer: Multiplan Commercial |
$45.06
|
| Rate for Payer: Networks By Design Commercial |
$39.05
|
| Rate for Payer: Prime Health Services Commercial |
$51.07
|
|
|
DEFERASIROX 500 MG DISPERSIBLE TABLET [43417]
|
Facility
|
OP
|
$233.89
|
|
|
Service Code
|
NDC 0078-0470-15
|
| Hospital Charge Code |
1712351
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.78 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.18
|
| Rate for Payer: Blue Distinction Transplant |
$140.33
|
| Rate for Payer: Blue Shield of California Commercial |
$147.12
|
| Rate for Payer: Blue Shield of California EPN |
$114.37
|
| Rate for Payer: Cash Price |
$105.25
|
| Rate for Payer: Central Health Plan Commercial |
$187.11
|
| Rate for Payer: Cigna of CA HMO |
$163.72
|
| Rate for Payer: Cigna of CA PPO |
$163.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.81
|
| Rate for Payer: Dignity Health Media |
$198.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.56
|
| Rate for Payer: Galaxy Health WC |
$198.81
|
| Rate for Payer: Global Benefits Group Commercial |
$140.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$175.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.78
|
| Rate for Payer: Multiplan Commercial |
$175.42
|
| Rate for Payer: Networks By Design Commercial |
$152.03
|
| Rate for Payer: Prime Health Services Commercial |
$198.81
|
| Rate for Payer: Riverside University Health System MISP |
$93.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.94
|
| Rate for Payer: United Healthcare All Other HMO |
$116.94
|
| Rate for Payer: United Healthcare HMO Rider |
$116.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.81
|
| Rate for Payer: Vantage Medical Group Senior |
$198.81
|
|
|
DEFERASIROX 500 MG DISPERSIBLE TABLET [43417]
|
Facility
|
IP
|
$233.89
|
|
|
Service Code
|
NDC 0078-0470-15
|
| Hospital Charge Code |
1712351
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.78 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Blue Shield of California Commercial |
$175.42
|
| Rate for Payer: Blue Shield of California EPN |
$124.90
|
| Rate for Payer: Cash Price |
$105.25
|
| Rate for Payer: Central Health Plan Commercial |
$187.11
|
| Rate for Payer: Cigna of CA HMO |
$163.72
|
| Rate for Payer: Cigna of CA PPO |
$163.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.56
|
| Rate for Payer: Galaxy Health WC |
$198.81
|
| Rate for Payer: Global Benefits Group Commercial |
$140.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.78
|
| Rate for Payer: Multiplan Commercial |
$175.42
|
| Rate for Payer: Networks By Design Commercial |
$152.03
|
| Rate for Payer: Prime Health Services Commercial |
$198.81
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
OP
|
$49.44
|
|
|
Service Code
|
CPT J0895
|
| Hospital Charge Code |
1712428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$53.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.35
|
| Rate for Payer: Blue Distinction Transplant |
$29.66
|
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Central Health Plan Commercial |
$39.55
|
| Rate for Payer: Cigna of CA HMO |
$34.61
|
| Rate for Payer: Cigna of CA PPO |
$34.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.02
|
| Rate for Payer: Dignity Health Media |
$42.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.02
|
| Rate for Payer: Global Benefits Group Commercial |
$29.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: Networks By Design Commercial |
$24.72
|
| Rate for Payer: Prime Health Services Commercial |
$42.02
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.72
|
| Rate for Payer: United Healthcare All Other HMO |
$24.72
|
| Rate for Payer: United Healthcare HMO Rider |
$24.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.02
|
| Rate for Payer: Vantage Medical Group Senior |
$42.02
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
IP
|
$49.44
|
|
|
Service Code
|
CPT J0895
|
| Hospital Charge Code |
1712428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Central Health Plan Commercial |
$39.55
|
| Rate for Payer: Cigna of CA HMO |
$34.61
|
| Rate for Payer: Cigna of CA PPO |
$34.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.02
|
| Rate for Payer: Global Benefits Group Commercial |
$29.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: Networks By Design Commercial |
$24.72
|
| Rate for Payer: Prime Health Services Commercial |
$42.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.67
|
| Rate for Payer: United Healthcare All Other HMO |
$18.23
|
| Rate for Payer: United Healthcare HMO Rider |
$17.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
CPT J0895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.22
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$11.66
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.73
|
| Rate for Payer: United Healthcare HMO Rider |
$5.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.13
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
OP
|
$15.54
|
|
|
Service Code
|
CPT J0895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$53.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.35
|
| Rate for Payer: Blue Distinction Transplant |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Media |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.22
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$11.66
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: Riverside University Health System MISP |
$6.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO |
$7.77
|
| Rate for Payer: United Healthcare HMO Rider |
$7.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$13.21
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
CPT J0895
|
| Hospital Charge Code |
1720046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.22
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$11.66
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.73
|
| Rate for Payer: United Healthcare HMO Rider |
$5.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.13
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
OP
|
$15.54
|
|
|
Service Code
|
CPT J0895
|
| Hospital Charge Code |
1720046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$53.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.35
|
| Rate for Payer: Blue Distinction Transplant |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Media |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.22
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$11.66
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: Riverside University Health System MISP |
$6.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO |
$7.77
|
| Rate for Payer: United Healthcare HMO Rider |
$7.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$13.21
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$61,161.32
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$38,628.20 |
| Max. Negotiated Rate |
$61,161.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46,031.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,161.32
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$102,947.59
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$65,019.53 |
| Max. Negotiated Rate |
$102,947.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$65,019.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77,481.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102,947.59
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$75,065.24
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$47,409.62 |
| Max. Negotiated Rate |
$75,065.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$47,409.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56,496.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75,065.24
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$53,968.17
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$34,085.16 |
| Max. Negotiated Rate |
$53,968.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,085.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40,618.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53,968.17
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$431.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$263.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.30
|
| Rate for Payer: Blue Distinction Transplant |
$287.71
|
| Rate for Payer: Blue Shield of California Commercial |
$301.62
|
| Rate for Payer: Blue Shield of California EPN |
$234.49
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Central Health Plan Commercial |
$383.62
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.59
|
| Rate for Payer: Dignity Health Media |
$407.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: Riverside University Health System MISP |
$191.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.76
|
| Rate for Payer: United Healthcare All Other HMO |
$239.76
|
| Rate for Payer: United Healthcare HMO Rider |
$239.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.59
|
| Rate for Payer: Vantage Medical Group Senior |
$407.59
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-02
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$431.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$263.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.30
|
| Rate for Payer: Blue Distinction Transplant |
$287.71
|
| Rate for Payer: Blue Shield of California Commercial |
$301.62
|
| Rate for Payer: Blue Shield of California EPN |
$234.49
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Central Health Plan Commercial |
$383.62
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.59
|
| Rate for Payer: Dignity Health Media |
$407.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: Riverside University Health System MISP |
$191.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.76
|
| Rate for Payer: United Healthcare All Other HMO |
$239.76
|
| Rate for Payer: United Healthcare HMO Rider |
$239.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.59
|
| Rate for Payer: Vantage Medical Group Senior |
$407.59
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-02
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$431.57 |
| Rate for Payer: Blue Shield of California Commercial |
$359.64
|
| Rate for Payer: Blue Shield of California EPN |
$256.06
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Central Health Plan Commercial |
$383.62
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.07
|
| Rate for Payer: United Healthcare All Other HMO |
$176.85
|
| Rate for Payer: United Healthcare HMO Rider |
$173.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.24
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$431.57 |
| Rate for Payer: Blue Shield of California Commercial |
$359.64
|
| Rate for Payer: Blue Shield of California EPN |
$256.06
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Central Health Plan Commercial |
$383.62
|
| Rate for Payer: Cigna of CA HMO |
$335.66
|
| Rate for Payer: Cigna of CA PPO |
$335.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.81
|
| Rate for Payer: Galaxy Health WC |
$407.59
|
| Rate for Payer: Global Benefits Group Commercial |
$287.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: Networks By Design Commercial |
$239.76
|
| Rate for Payer: Prime Health Services Commercial |
$407.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.07
|
| Rate for Payer: United Healthcare All Other HMO |
$176.85
|
| Rate for Payer: United Healthcare HMO Rider |
$173.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.24
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$13,144.88
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$8,302.03 |
| Max. Negotiated Rate |
$13,144.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,302.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,893.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,144.88
|
|
