|
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: AlphaCare Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$11.66
|
| Rate for Payer: IEHP medi-cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| 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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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: 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$11.66
|
| Rate for Payer: IEHP medi-cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| 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 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
|
$77,481.60
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$77,481.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$65,019.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$77,481.60
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$56,496.47
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$56,496.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$47,409.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$56,496.47
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$40,618.15
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$40,618.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,085.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$40,618.15
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$46,031.94
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$46,031.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,628.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$46,031.94
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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: 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 Transplant Other |
$359.64
|
| Rate for Payer: IEHP medi-cal |
$167.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| 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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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: 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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: 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 Transplant Other |
$359.64
|
| Rate for Payer: IEHP medi-cal |
$167.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.84
|
| 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 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 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.90 |
| 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 |
$359.64
|
| Rate for Payer: Blue Shield of California EPN |
$256.06
|
| Rate for Payer: Cash Price |
$215.78
|
| 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: 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
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$11,170.56 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,170.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$13,311.58
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$6,541.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,541.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,795.02
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$19,890.38 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,890.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$23,702.71
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$8,302.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,302.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$9,893.25
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 056
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 057
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| 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 |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet
|
Facility
OP
|
$10,567.00
|
|
|
Service Code
|
CPT 15620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| 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 |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: BCBS Transplant Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.24
|
| Rate for Payer: IEHP medi-cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: Riverside University Health MISP |
$3.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: BCBS Transplant Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.24
|
| Rate for Payer: IEHP medi-cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: Riverside University Health MISP |
$3.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| 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 |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.44
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| 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 |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.44
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
IP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| 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 |
$11.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Central Health Plan Commercial |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
OP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.94
|
| Rate for Payer: BCBS Transplant Transplant |
$9.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$7.40
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Central Health Plan Commercial |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.35
|
| Rate for Payer: IEHP medi-cal |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.08
|
| Rate for Payer: Riverside University Health MISP |
$6.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.56
|
| Rate for Payer: United Healthcare All Other HMO |
$7.56
|
| Rate for Payer: United Healthcare HMO Rider |
$7.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.86
|
| Rate for Payer: Vantage Medical Group Senior |
$12.86
|
|
