|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 0173-0712-04
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Blue Shield of California Commercial |
$8.25
|
| Rate for Payer: Blue Shield of California EPN |
$5.87
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 0173-0712-04
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$12,660.73
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$7,996.25 |
| Max. Negotiated Rate |
$12,660.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,996.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,528.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,660.73
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$29,866.84
|
|
|
Service Code
|
APR-DRG 1104
|
| Min. Negotiated Rate |
$18,863.27 |
| Max. Negotiated Rate |
$29,866.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,863.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,478.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,866.84
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$18,341.12
|
|
|
Service Code
|
APR-DRG 1103
|
| Min. Negotiated Rate |
$11,583.86 |
| Max. Negotiated Rate |
$18,341.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,583.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,804.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,341.12
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$11,068.16
|
|
|
Service Code
|
APR-DRG 1101
|
| Min. Negotiated Rate |
$6,990.42 |
| Max. Negotiated Rate |
$11,068.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,990.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,330.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,068.16
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$83,529.97
|
|
|
Service Code
|
APR-DRG 7594
|
| Min. Negotiated Rate |
$52,755.77 |
| Max. Negotiated Rate |
$83,529.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$52,755.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62,867.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83,529.97
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$14,615.08
|
|
|
Service Code
|
APR-DRG 7592
|
| Min. Negotiated Rate |
$9,230.58 |
| Max. Negotiated Rate |
$14,615.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,230.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,999.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,615.08
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$20,219.21
|
|
|
Service Code
|
APR-DRG 7593
|
| Min. Negotiated Rate |
$12,770.03 |
| Max. Negotiated Rate |
$20,219.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,770.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,217.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,219.21
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$9,339.03
|
|
|
Service Code
|
APR-DRG 7591
|
| Min. Negotiated Rate |
$5,898.34 |
| Max. Negotiated Rate |
$9,339.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,898.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,028.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,339.03
|
|
|
ECONAZOLE 1 % TOPICAL CREAM [9915]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 51672-1303-1
|
| Hospital Charge Code |
NDG9915
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Media |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Riverside University Health System MISP |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
ECONAZOLE 1 % TOPICAL CREAM [9915]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 51672-1303-1
|
| Hospital Charge Code |
NDG9915
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION [81696]
|
Facility
|
IP
|
$260.92
|
|
|
Service Code
|
CPT J1300
|
| Hospital Charge Code |
NDG81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.18 |
| Max. Negotiated Rate |
$234.83 |
| Rate for Payer: Blue Shield of California Commercial |
$195.69
|
| Rate for Payer: Blue Shield of California EPN |
$139.33
|
| Rate for Payer: Cash Price |
$117.41
|
| Rate for Payer: Central Health Plan Commercial |
$208.74
|
| Rate for Payer: Cigna of CA HMO |
$182.64
|
| Rate for Payer: Cigna of CA PPO |
$182.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.37
|
| Rate for Payer: Galaxy Health WC |
$221.78
|
| Rate for Payer: Global Benefits Group Commercial |
$156.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.18
|
| Rate for Payer: Multiplan Commercial |
$195.69
|
| Rate for Payer: Networks By Design Commercial |
$130.46
|
| Rate for Payer: Prime Health Services Commercial |
$221.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.52
|
| Rate for Payer: United Healthcare All Other HMO |
$96.23
|
| Rate for Payer: United Healthcare HMO Rider |
$94.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.10
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION [81696]
|
Facility
|
OP
|
$260.92
|
|
|
Service Code
|
CPT J1300
|
| Hospital Charge Code |
NDG81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.18 |
| Max. Negotiated Rate |
$1,398.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$225.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,398.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$343.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.56
|
| Rate for Payer: Blue Distinction Transplant |
$156.55
|
| Rate for Payer: Blue Shield of California Commercial |
$287.01
|
| Rate for Payer: Blue Shield of California EPN |
$260.92
|
| Rate for Payer: Caremore Medicare Advantage |
$225.68
|
| Rate for Payer: Cash Price |
$117.41
|
| Rate for Payer: Cash Price |
$117.41
|
| Rate for Payer: Central Health Plan Commercial |
$208.74
|
| Rate for Payer: Cigna of CA HMO |
$182.64
|
| Rate for Payer: Cigna of CA PPO |
$182.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.53
|
| Rate for Payer: Dignity Health Media |
$225.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$225.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$225.68
|
| Rate for Payer: Galaxy Health WC |
$221.78
|
| Rate for Payer: Global Benefits Group Commercial |
$156.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$195.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$372.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.68
|
| Rate for Payer: InnovAge PACE Commercial |
$338.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.42
|
| Rate for Payer: Multiplan Commercial |
$195.69
|
| Rate for Payer: Networks By Design Commercial |
$130.46
|
| Rate for Payer: Prime Health Services Commercial |
$221.78
|
| Rate for Payer: Prime Health Services Medicare |
$239.23
|
| Rate for Payer: Riverside University Health System MISP |
$248.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.46
|
| Rate for Payer: United Healthcare All Other HMO |
$130.46
|
| Rate for Payer: United Healthcare HMO Rider |
$130.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.68
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJECTION SOLUTION [9916]
|
Facility
|
OP
|
$1,292.51
|
|
|
Service Code
|
CPT J0600
|
| Hospital Charge Code |
NDG9916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$39,689.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,452.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39,689.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,065.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,097.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,097.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.26
|
| Rate for Payer: Blue Distinction Transplant |
$775.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7,108.82
|
| Rate for Payer: Blue Shield of California EPN |
$6,462.56
|
| Rate for Payer: Caremore Medicare Advantage |
$6,452.50
|
| Rate for Payer: Cash Price |
$581.63
|
| Rate for Payer: Cash Price |
$581.63
|
| Rate for Payer: Central Health Plan Commercial |
$1,034.01
|
| Rate for Payer: Cigna of CA HMO |
$904.76
|
| Rate for Payer: Cigna of CA PPO |
$904.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,678.75
|
| Rate for Payer: Dignity Health Media |
$6,452.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,097.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,710.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,452.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,452.50
|
| Rate for Payer: Galaxy Health WC |
$1,098.63
|
| Rate for Payer: Global Benefits Group Commercial |
$775.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,163.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$969.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,582.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,646.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,452.50
|
| Rate for Payer: InnovAge PACE Commercial |
$9,678.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$862.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,452.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,646.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,646.35
|
| Rate for Payer: Multiplan Commercial |
$969.38
|
| Rate for Payer: Networks By Design Commercial |
$646.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.63
|
| Rate for Payer: Prime Health Services Medicare |
$6,839.65
|
| Rate for Payer: Riverside University Health System MISP |
$7,097.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$775.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$775.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$646.26
|
| Rate for Payer: United Healthcare All Other HMO |
$646.26
|
| Rate for Payer: United Healthcare HMO Rider |
$646.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,678.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,097.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,452.50
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJECTION SOLUTION [9916]
|
Facility
|
IP
|
$1,292.51
|
|
|
Service Code
|
CPT J0600
|
| Hospital Charge Code |
NDG9916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$1,163.26 |
| Rate for Payer: Blue Shield of California Commercial |
$969.38
|
| Rate for Payer: Blue Shield of California EPN |
$690.20
|
| Rate for Payer: Cash Price |
$581.63
|
| Rate for Payer: Central Health Plan Commercial |
$1,034.01
|
| Rate for Payer: Cigna of CA HMO |
$904.76
|
| Rate for Payer: Cigna of CA PPO |
$904.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$517.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$517.00
|
| Rate for Payer: Galaxy Health WC |
$1,098.63
|
| Rate for Payer: Global Benefits Group Commercial |
$775.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,163.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$862.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Multiplan Commercial |
$969.38
|
| Rate for Payer: Networks By Design Commercial |
$646.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$488.05
|
| Rate for Payer: United Healthcare All Other HMO |
$476.68
|
| Rate for Payer: United Healthcare HMO Rider |
$466.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.53
|
|
|
EDETATE DISODIUM 3 % EYE DROPS [222529]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG222529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Blue Distinction Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.87
|
| Rate for Payer: Blue Shield of California EPN |
$14.67
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Media |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
EDETATE DISODIUM 3 % EYE DROPS [222529]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG222529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22.50
|
| Rate for Payer: Blue Shield of California EPN |
$16.02
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Other HMO |
$11.06
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
|
|
EFAVIRENZ 600 MG TABLET [32298]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 31722-504-30
|
| Hospital Charge Code |
1711878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Blue Distinction Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
EFAVIRENZ 600 MG TABLET [32298]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 31722-504-30
|
| Hospital Charge Code |
1711878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
EFLAPEGRASTIM-XNST 13.2 MG/0.6 ML SUBCUTANEOUS SYRINGE [235968]
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
CPT J1449
|
| Hospital Charge Code |
NDG235968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$8,100.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6,750.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,806.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,200.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.00
|
| Rate for Payer: Cigna of CA PPO |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,600.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,600.00
|
| Rate for Payer: Galaxy Health WC |
$7,650.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,429.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Multiplan Commercial |
$6,750.00
|
| Rate for Payer: Networks By Design Commercial |
$4,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,650.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,398.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3,319.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3,247.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,970.00
|
|
|
EFLAPEGRASTIM-XNST 13.2 MG/0.6 ML SUBCUTANEOUS SYRINGE [235968]
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
CPT J1449
|
| Hospital Charge Code |
NDG235968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$8,100.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,357.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,317.20
|
| Rate for Payer: Blue Distinction Transplant |
$5,400.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,401.00
|
| Rate for Payer: Caremore Medicare Advantage |
$29.68
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,200.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.00
|
| Rate for Payer: Cigna of CA PPO |
$6,300.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.10
|
| Rate for Payer: Dignity Health Media |
$32.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.68
|
| Rate for Payer: Galaxy Health WC |
$7,650.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,100.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,750.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.68
|
| Rate for Payer: InnovAge PACE Commercial |
$44.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.77
|
| Rate for Payer: Multiplan Commercial |
$6,750.00
|
| Rate for Payer: Networks By Design Commercial |
$4,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,650.00
|
| Rate for Payer: Prime Health Services Medicare |
$31.46
|
| Rate for Payer: Riverside University Health System MISP |
$32.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.65
|
| Rate for Payer: Vantage Medical Group Senior |
$32.65
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$34,694.19
|
|
|
Service Code
|
APR-DRG 3243
|
| Min. Negotiated Rate |
$21,912.12 |
| Max. Negotiated Rate |
$34,694.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,912.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,111.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,694.19
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$55,058.85
|
|
|
Service Code
|
APR-DRG 3244
|
| Min. Negotiated Rate |
$34,774.01 |
| Max. Negotiated Rate |
$55,058.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,774.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,439.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55,058.85
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$25,706.30
|
|
|
Service Code
|
APR-DRG 3242
|
| Min. Negotiated Rate |
$16,235.56 |
| Max. Negotiated Rate |
$25,706.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,235.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,347.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,706.30
|
|
