|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
IP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.87 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,582.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,126.39
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Central Health Plan Commercial |
$1,687.48
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$843.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,898.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.87
|
| Rate for Payer: Multiplan Commercial |
$1,582.01
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
OP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1,265.61
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Caremore Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Central Health Plan Commercial |
$1,687.48
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,898.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,582.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.32
|
| Rate for Payer: IEHP medi-cal |
$41.58
|
| Rate for Payer: IEHP Medicare Advantage |
$25.20
|
| Rate for Payer: Innovage PACE Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,582.01
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
| Rate for Payer: Prime Health Services Medicare |
$26.71
|
| Rate for Payer: Riverside University Health MISP |
$27.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,265.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,265.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,054.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,054.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,054.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
OP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1,169.67
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Caremore Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.56
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,462.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.32
|
| Rate for Payer: IEHP medi-cal |
$41.58
|
| Rate for Payer: IEHP Medicare Advantage |
$25.20
|
| Rate for Payer: Innovage PACE Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,462.09
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
| Rate for Payer: Prime Health Services Medicare |
$26.71
|
| Rate for Payer: Riverside University Health MISP |
$27.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,169.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$974.72
|
| Rate for Payer: United Healthcare All Other HMO |
$974.72
|
| Rate for Payer: United Healthcare HMO Rider |
$974.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$974.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
IP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$389.89 |
| 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 |
$1,462.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.01
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.56
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$779.78
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.89
|
| Rate for Payer: Multiplan Commercial |
$1,462.09
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
|
|
DENTAL AND ORAL DISEASES AGE 0-17
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 119
|
| 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
|
|
|
DENTAL AND ORAL DISEASES AGE >17 WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 158
|
| 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
|
|
|
DENTAL AND ORAL DISEASES AGE >17 WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 157
|
| 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
|
|
|
DENTAL AND ORAL DISEASES AGE >17 WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 159
|
| 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
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$3,862.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,862.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$4,602.25
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$14,984.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,984.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$17,856.45
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$8,561.89 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,561.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,202.92
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$5,330.46 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,330.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$6,352.13
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7541
|
| Min. Negotiated Rate |
$3,206.78 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,206.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$3,821.42
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7542
|
| Min. Negotiated Rate |
$4,289.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,289.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,112.14
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7544
|
| Min. Negotiated Rate |
$14,395.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,395.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$17,154.37
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7543
|
| Min. Negotiated Rate |
$6,806.72 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,806.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$8,111.35
|
|
|
DEPRESSIVE NEUROSES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 881
|
| 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
|
|
|
Dermabrasion; segmental, face
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 15781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$879.07 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,241.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$1,450.47
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Innovage PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health MISP |
$966.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Dermabrasion; superficial, any site (eg, tattoo removal)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 15783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$498.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,950.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
1710265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| 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 |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
OP
|
$1.35
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
1710265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: BCBS Transplant Transplant |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.01
|
| Rate for Payer: IEHP medi-cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: Riverside University Health MISP |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.15
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
IP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
1711734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| 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 |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
OP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
1711734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.66
|
| Rate for Payer: IEHP medi-cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: Riverside University Health MISP |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
IP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
1711735
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| 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 |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
OP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
1711735
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: BCBS Transplant Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.74
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
