|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1.27
|
| Rate for Payer: BCBS Transplant Transplant |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.20
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Riverside University Health MISP |
$3.84
|
| Rate for Payer: Riverside University Health MISP |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$4.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$4.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1.79
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
IP
|
$2.11
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.79
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.58
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.79
|
| Rate for Payer: Riverside University Health MISP |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Vantage Medical Group Senior |
$1.79
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
IP
|
$2.11
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]
|
Facility
OP
|
$12.96
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
NDG230343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$7.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.37
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$9.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.72
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Networks By Design Commercial |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Riverside University Health MISP |
$5.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]
|
Facility
IP
|
$12.96
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
NDG230343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Blue Shield of California Commercial |
$9.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.92
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.37
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$9.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Networks By Design Commercial |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
IP
|
$3.20
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721187
|
|
Hospital Revenue Code
|
636
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| 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 |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$1.44
|
| 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: 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 Transplant Other |
$2.40
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| 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 |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health 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
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.81
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Riverside University Health MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
IP
|
$13.03
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
1740156
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Blue Shield of California Commercial |
$9.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
IP
|
$10.56
|
|
|
Service Code
|
NDC 17478-215-15
|
| Hospital Charge Code |
NDG736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Shield of California Commercial |
$7.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.64
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
OP
|
$10.56
|
|
|
Service Code
|
NDC 17478-215-15
|
| Hospital Charge Code |
NDG736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.24
|
| Rate for Payer: BCBS Transplant Transplant |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.64
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.92
|
| Rate for Payer: IEHP medi-cal |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: Riverside University Health MISP |
$4.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
OP
|
$13.03
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
1740156
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.70
|
| Rate for Payer: BCBS Transplant Transplant |
$7.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.77
|
| Rate for Payer: IEHP medi-cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: Riverside University Health MISP |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
IP
|
$21.54
|
|
|
Service Code
|
NDC 60219-1748-2
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Blue Shield of California Commercial |
$16.16
|
| Rate for Payer: Blue Shield of California EPN |
$11.50
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Central Health Plan Commercial |
$17.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$16.16
|
| Rate for Payer: Networks By Design Commercial |
$14.00
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
OP
|
$21.54
|
|
|
Service Code
|
NDC 60219-1748-2
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.73
|
| Rate for Payer: BCBS Transplant Transplant |
$12.92
|
| Rate for Payer: Blue Shield of California Commercial |
$13.55
|
| Rate for Payer: Blue Shield of California EPN |
$10.53
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Central Health Plan Commercial |
$17.23
|
| Rate for Payer: Cigna of CA HMO |
$13.79
|
| Rate for Payer: Cigna of CA PPO |
$15.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.62
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.16
|
| Rate for Payer: IEHP medi-cal |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$16.16
|
| Rate for Payer: Networks By Design Commercial |
$14.00
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
| Rate for Payer: Riverside University Health MISP |
$8.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Other HMO |
$10.77
|
| Rate for Payer: United Healthcare HMO Rider |
$10.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.31
|
| Rate for Payer: Vantage Medical Group Senior |
$18.31
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
NDC 0065-0817-02
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.21
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
NDC 0065-0817-02
|
| Hospital Charge Code |
1740347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.41
|
| Rate for Payer: BCBS Transplant Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.27
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.75
|
| Rate for Payer: IEHP medi-cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Riverside University Health MISP |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.85
|
| Rate for Payer: Vantage Medical Group Senior |
$17.85
|
|
|
ATROPINE 1 % EYE OINTMENT [735]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 24208-825-55
|
| Hospital Charge Code |
1740063
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
ATROPINE 1 % EYE OINTMENT [735]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 24208-825-55
|
| Hospital Charge Code |
1740063
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION [734]
|
Facility
IP
|
$15.07
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Blue Shield of California Commercial |
$11.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.05
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Central Health Plan Commercial |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Cigna of CA PPO |
$10.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$12.81
|
| Rate for Payer: Global Benefits Group Commercial |
$9.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.01
|
| Rate for Payer: Multiplan Commercial |
$11.30
|
| Rate for Payer: Networks By Design Commercial |
$7.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.81
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION [734]
|
Facility
OP
|
$15.07
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
1721185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$9.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Central Health Plan Commercial |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Cigna of CA PPO |
$10.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$12.81
|
| Rate for Payer: Global Benefits Group Commercial |
$9.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.30
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.01
|
| Rate for Payer: Multiplan Commercial |
$11.30
|
| Rate for Payer: Networks By Design Commercial |
$7.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.81
|
| Rate for Payer: Riverside University Health MISP |
$6.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.54
|
| Rate for Payer: United Healthcare HMO Rider |
$7.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.81
|
| Rate for Payer: Vantage Medical Group Senior |
$12.81
|
|
|
ATROPINE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080421]
|
Facility
OP
|
$2.10
|
|
|
Service Code
|
NDC 9994-0804-21
|
| Hospital Charge Code |
1721189
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: BCBS Transplant Transplant |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.58
|
| Rate for Payer: IEHP medi-cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.36
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: Riverside University Health MISP |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
|
|
ATROPINE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080421]
|
Facility
IP
|
$2.10
|
|
|
Service Code
|
NDC 9994-0804-21
|
| Hospital Charge Code |
1721189
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.36
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
|
|
Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 20936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
|
