|
Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 66179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,530.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$6,530.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,815.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,530.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,709.54
|
| Rate for Payer: IEHP medi-cal |
$10,774.85
|
| Rate for Payer: IEHP Medicare Advantage |
$6,530.21
|
| Rate for Payer: Innovage PACE Commercial |
$9,795.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,530.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.48
|
| Rate for Payer: Prime Health Services Medicare |
$6,922.02
|
| Rate for Payer: Riverside University Health MISP |
$7,183.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-02
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.48
|
| Rate for Payer: BCBS Transplant Transplant |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.88
|
| Rate for Payer: IEHP medi-cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: Riverside University Health MISP |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$11.26
|
|
|
Service Code
|
NDC 63402-911-01
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.65
|
| Rate for Payer: BCBS Transplant Transplant |
$6.76
|
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.51
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.88
|
| Rate for Payer: Cigna of CA PPO |
$7.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.44
|
| Rate for Payer: IEHP medi-cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.44
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: Riverside University Health MISP |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.63
|
| Rate for Payer: United Healthcare HMO Rider |
$5.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.57
|
| Rate for Payer: Vantage Medical Group Senior |
$9.57
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$11.26
|
|
|
Service Code
|
NDC 63402-911-64
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Blue Shield of California Commercial |
$8.44
|
| Rate for Payer: Blue Shield of California EPN |
$6.01
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.88
|
| Rate for Payer: Cigna of CA PPO |
$7.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.44
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$11.26
|
|
|
Service Code
|
NDC 63402-911-30
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Blue Shield of California Commercial |
$8.44
|
| Rate for Payer: Blue Shield of California EPN |
$6.01
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.88
|
| Rate for Payer: Cigna of CA PPO |
$7.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.44
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-56
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.89
|
| Rate for Payer: IEHP medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: Riverside University Health MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$11.26
|
|
|
Service Code
|
NDC 63402-911-30
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.65
|
| Rate for Payer: BCBS Transplant Transplant |
$6.76
|
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.51
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.88
|
| Rate for Payer: Cigna of CA PPO |
$7.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.44
|
| Rate for Payer: IEHP medi-cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.44
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: Riverside University Health MISP |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.63
|
| Rate for Payer: United Healthcare HMO Rider |
$5.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.57
|
| Rate for Payer: Vantage Medical Group Senior |
$9.57
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-11
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.89
|
| Rate for Payer: IEHP medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: Riverside University Health MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-56
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-06
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-01
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.48
|
| Rate for Payer: BCBS Transplant Transplant |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.88
|
| Rate for Payer: IEHP medi-cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: Riverside University Health MISP |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-01
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-06
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.89
|
| Rate for Payer: IEHP medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: Riverside University Health MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-11
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
OP
|
$11.26
|
|
|
Service Code
|
NDC 63402-911-64
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.65
|
| Rate for Payer: BCBS Transplant Transplant |
$6.76
|
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.51
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.88
|
| Rate for Payer: Cigna of CA PPO |
$7.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.44
|
| Rate for Payer: IEHP medi-cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.44
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: Riverside University Health MISP |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.63
|
| Rate for Payer: United Healthcare HMO Rider |
$5.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.57
|
| Rate for Payer: Vantage Medical Group Senior |
$9.57
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-02
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
IP
|
$11.26
|
|
|
Service Code
|
NDC 63402-911-01
|
| Hospital Charge Code |
1744128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Blue Shield of California Commercial |
$8.44
|
| Rate for Payer: Blue Shield of California EPN |
$6.01
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.88
|
| Rate for Payer: Cigna of CA PPO |
$7.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.44
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]
|
Facility
IP
|
$130.41
|
|
|
Service Code
|
CPT J0883
|
| Hospital Charge Code |
1759990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Blue Shield of California Commercial |
$97.81
|
| Rate for Payer: Blue Shield of California Commercial |
$183.60
|
| Rate for Payer: Blue Shield of California EPN |
$69.64
|
| Rate for Payer: Blue Shield of California EPN |
$130.72
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Central Health Plan Commercial |
$195.84
|
| Rate for Payer: Central Health Plan Commercial |
$104.33
|
| Rate for Payer: Cigna of CA HMO |
$91.29
|
| Rate for Payer: Cigna of CA HMO |
$171.36
|
| Rate for Payer: Cigna of CA PPO |
$171.36
|
| Rate for Payer: Cigna of CA PPO |
$91.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.16
|
| Rate for Payer: Galaxy Health WC |
$110.85
|
| Rate for Payer: Galaxy Health WC |
$208.08
|
| Rate for Payer: Global Benefits Group Commercial |
$146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.08
|
| Rate for Payer: Multiplan Commercial |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$97.81
|
| Rate for Payer: Networks By Design Commercial |
$65.20
|
| Rate for Payer: Networks By Design Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Commercial |
$110.85
|
| Rate for Payer: Prime Health Services Commercial |
$208.08
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]
|
Facility
OP
|
$130.41
|
|
|
Service Code
|
CPT J0883
|
| Hospital Charge Code |
1759990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.83
|
| Rate for Payer: BCBS Transplant Transplant |
$78.25
|
| Rate for Payer: BCBS Transplant Transplant |
$146.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Caremore Medicare Advantage |
$1.22
|
| Rate for Payer: Caremore Medicare Advantage |
$1.22
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Central Health Plan Commercial |
$104.33
|
| Rate for Payer: Central Health Plan Commercial |
$195.84
|
| Rate for Payer: Cigna of CA HMO |
$171.36
|
| Rate for Payer: Cigna of CA HMO |
$91.29
|
| Rate for Payer: Cigna of CA PPO |
$171.36
|
| Rate for Payer: Cigna of CA PPO |
$91.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$208.08
|
| Rate for Payer: Galaxy Health WC |
$110.85
|
| Rate for Payer: Global Benefits Group Commercial |
$146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$183.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$97.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.01
|
| Rate for Payer: IEHP medi-cal |
$2.01
|
| Rate for Payer: IEHP Medicare Advantage |
$1.22
|
| Rate for Payer: IEHP Medicare Advantage |
$1.22
|
| Rate for Payer: Innovage PACE Commercial |
$1.83
|
| Rate for Payer: Innovage PACE Commercial |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$97.81
|
| Rate for Payer: Multiplan Commercial |
$183.60
|
| Rate for Payer: Networks By Design Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$65.20
|
| Rate for Payer: Prime Health Services Commercial |
$208.08
|
| Rate for Payer: Prime Health Services Commercial |
$110.85
|
| Rate for Payer: Prime Health Services Medicare |
$1.29
|
| Rate for Payer: Prime Health Services Medicare |
$1.29
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.40
|
| Rate for Payer: United Healthcare All Other HMO |
$122.40
|
| Rate for Payer: United Healthcare All Other HMO |
$65.20
|
| Rate for Payer: United Healthcare HMO Rider |
$122.40
|
| Rate for Payer: United Healthcare HMO Rider |
$65.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
ARGININE 25 MG/ML-LYSINE 25 MG/ML IN 0.9 % NACL INTRAVENOUS SOLUTION [223945]
|
Facility
OP
|
$0.45
|
|
|
Service Code
|
NDC 08252-0001-75
|
| Hospital Charge Code |
NDG223945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: BCBS Transplant Transplant |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.34
|
| Rate for Payer: IEHP medi-cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Riverside University Health MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
ARGININE 25 MG/ML-LYSINE 25 MG/ML IN 0.9 % NACL INTRAVENOUS SOLUTION [223945]
|
Facility
IP
|
$0.45
|
|
|
Service Code
|
NDC 08252-0001-75
|
| Hospital Charge Code |
NDG223945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [220244]
|
Facility
OP
|
$2.84
|
|
|
Service Code
|
NDC 5978166694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.13
|
| Rate for Payer: IEHP medi-cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: Riverside University Health MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [220244]
|
Facility
IP
|
$2.84
|
|
|
Service Code
|
NDC 5978166694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
|
ARGININE HCL (L-ARGININE) 10 % CONTINUOUS INFUSION [203805]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 0009-0436-01
|
| Hospital Charge Code |
NDG9123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
ARGININE HCL (L-ARGININE) 10 % CONTINUOUS INFUSION [203805]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 0009-0436-01
|
| Hospital Charge Code |
NDG9123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
