|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Distinction Transplant |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Media |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$1.42
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.21
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 60687-551-11
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.82
|
| Rate for Payer: Blue Distinction Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.18
|
| Rate for Payer: Dignity Health Media |
$1.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1.18
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 60687-551-11
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Distinction Transplant |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Media |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [110919]
|
Facility
|
IP
|
$75.82
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$68.24 |
| Rate for Payer: Blue Shield of California Commercial |
$56.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$40.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.64
|
| Rate for Payer: Central Health Plan Commercial |
$60.66
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$53.07
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$53.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$64.45
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$45.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$56.86
|
| Rate for Payer: Networks By Design Commercial |
$37.91
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Prime Health Services Commercial |
$64.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.63
|
| Rate for Payer: United Healthcare All Other HMO |
$27.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.09
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [110919]
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: Blue Distinction Transplant |
$45.49
|
| Rate for Payer: Blue Distinction Transplant |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7.74
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.64
|
| Rate for Payer: Central Health Plan Commercial |
$60.66
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$53.07
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$53.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.80
|
| Rate for Payer: Dignity Health Media |
$64.45
|
| Rate for Payer: Dignity Health Media |
$2.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$64.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$45.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$56.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$56.86
|
| Rate for Payer: Networks By Design Commercial |
$37.91
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Prime Health Services Commercial |
$64.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: Riverside University Health System MISP |
$1.32
|
| Rate for Payer: Riverside University Health System MISP |
$30.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.91
|
| Rate for Payer: United Healthcare All Other HMO |
$37.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.65
|
| Rate for Payer: United Healthcare HMO Rider |
$37.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Vantage Medical Group Senior |
$64.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.80
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
1715678
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: Blue Distinction Transplant |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Media |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
| Rate for Payer: Riverside University Health System MISP |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
1715678
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]
|
Facility
|
IP
|
$5,518.80
|
|
|
Service Code
|
CPT J1162
|
| Hospital Charge Code |
1712460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,103.76 |
| Max. Negotiated Rate |
$4,966.92 |
| Rate for Payer: Blue Shield of California Commercial |
$4,139.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,947.04
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Central Health Plan Commercial |
$4,415.04
|
| Rate for Payer: Cigna of CA HMO |
$3,863.16
|
| Rate for Payer: Cigna of CA PPO |
$3,863.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,207.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,207.52
|
| Rate for Payer: Galaxy Health WC |
$4,690.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,966.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,103.76
|
| Rate for Payer: Multiplan Commercial |
$4,139.10
|
| Rate for Payer: Networks By Design Commercial |
$2,759.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,690.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,083.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,035.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,991.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,821.20
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]
|
Facility
|
OP
|
$5,518.80
|
|
|
Service Code
|
CPT J1162
|
| Hospital Charge Code |
1712460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,103.76 |
| Max. Negotiated Rate |
$29,606.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,777.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29,606.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,971.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,255.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,255.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,250.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,369.23
|
| Rate for Payer: Blue Distinction Transplant |
$3,311.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5,245.68
|
| Rate for Payer: Blue Shield of California EPN |
$4,768.80
|
| Rate for Payer: Caremore Medicare Advantage |
$4,777.44
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Central Health Plan Commercial |
$4,415.04
|
| Rate for Payer: Cigna of CA HMO |
$3,863.16
|
| Rate for Payer: Cigna of CA PPO |
$3,863.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,166.16
|
| Rate for Payer: Dignity Health Media |
$4,777.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,255.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,449.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,777.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,777.44
|
| Rate for Payer: Galaxy Health WC |
$4,690.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,966.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,139.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,835.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,882.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,777.44
|
| Rate for Payer: InnovAge PACE Commercial |
$7,166.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,085.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,777.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,103.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,401.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,401.77
|
| Rate for Payer: Multiplan Commercial |
$4,139.10
|
| Rate for Payer: Networks By Design Commercial |
$2,759.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,690.98
|
| Rate for Payer: Prime Health Services Medicare |
$5,064.09
|
| Rate for Payer: Riverside University Health System MISP |
$5,255.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,311.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,311.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,759.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,759.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,759.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,759.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,166.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,255.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.44
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
1720065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$262.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$262.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.11
|
| Rate for Payer: Blue Distinction Transplant |
$60.63
|
| Rate for Payer: Blue Shield of California Commercial |
$164.71
|
| Rate for Payer: Blue Shield of California EPN |
$149.74
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Central Health Plan Commercial |
$80.84
|
| Rate for Payer: Cigna of CA HMO |
$70.74
|
| Rate for Payer: Cigna of CA PPO |
$70.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.89
|
| Rate for Payer: Dignity Health Media |
$85.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.42
|
| Rate for Payer: Galaxy Health WC |
$85.89
|
| Rate for Payer: Global Benefits Group Commercial |
$60.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$75.79
|
| Rate for Payer: Networks By Design Commercial |
$50.52
|
| Rate for Payer: Prime Health Services Commercial |
$85.89
|
| Rate for Payer: Riverside University Health System MISP |
$40.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.52
|
| Rate for Payer: United Healthcare All Other HMO |
$50.52
|
| Rate for Payer: United Healthcare HMO Rider |
$50.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.89
|
| Rate for Payer: Vantage Medical Group Senior |
$85.89
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
1720065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Blue Shield of California Commercial |
$75.79
|
| Rate for Payer: Blue Shield of California EPN |
$53.96
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Central Health Plan Commercial |
$80.84
|
| Rate for Payer: Cigna of CA HMO |
$70.74
|
| Rate for Payer: Cigna of CA PPO |
$70.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.42
|
| Rate for Payer: Galaxy Health WC |
$85.89
|
| Rate for Payer: Global Benefits Group Commercial |
$60.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$75.79
|
| Rate for Payer: Networks By Design Commercial |
$50.52
|
| Rate for Payer: Prime Health Services Commercial |
$85.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.16
|
| Rate for Payer: United Healthcare All Other HMO |
$37.27
|
| Rate for Payer: United Healthcare HMO Rider |
$36.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.35
|
|
|
Dilation and catheterization of salivary duct, with or without injection
|
Facility
|
OP
|
$4,846.00
|
|
|
Service Code
|
CPT 42660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.27 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$687.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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 |
$687.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,134.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| 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 |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.60 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| 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 |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$39,557.03
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$24,983.39 |
| Max. Negotiated Rate |
$39,557.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,983.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29,771.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,557.03
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$22,489.26
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$14,203.74 |
| Max. Negotiated Rate |
$22,489.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,203.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,926.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,489.26
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$10,555.64
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$6,666.72 |
| Max. Negotiated Rate |
$10,555.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,666.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,944.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,555.64
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$13,398.50
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$8,462.21 |
| Max. Negotiated Rate |
$13,398.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,462.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,084.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,398.50
|
|
|
Dilation of esophagus, by unguided sound or bougie, single or multiple passes
|
Facility
|
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 43450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$88.43 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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 |
$1,132.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
Dilation of esophagus, over guide wire
|
Facility
|
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 43453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.99 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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 |
$2,377.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Dilation of female urethra, general or conduction (spinal) anesthesia
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 53665
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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 |
$2,544.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
