|
ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| 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 Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.49
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.55
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.49
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
HCPCS J0463
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Central Health Plan Commercial |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1.83
|
| Rate for Payer: Galaxy Health WC |
$3.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Prime Health Services Commercial |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
HCPCS J0463
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Central Health Plan Commercial |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1.83
|
| Rate for Payer: Galaxy Health WC |
$3.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Prime Health Services Commercial |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$1.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: Vantage Medical Group Senior |
$3.89
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Adventist Health Commercial |
$2.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.44
|
| 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 |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Central Health Plan Commercial |
$10.22
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$8.94
|
| Rate for Payer: Cigna of CA HMO |
$9.74
|
| Rate for Payer: Cigna of CA PPO |
$9.74
|
| Rate for Payer: Cigna of CA PPO |
$8.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.83
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.74
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.83
|
| Rate for Payer: Riverside University Health System MISP |
$5.57
|
| Rate for Payer: Riverside University Health System MISP |
$5.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.83
|
| Rate for Payer: Vantage Medical Group Senior |
$11.83
|
| Rate for Payer: Vantage Medical Group Senior |
$10.85
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [230343]
|
Facility
|
IP
|
$13.92
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$12.53 |
| Rate for Payer: Adventist Health Commercial |
$2.78
|
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$11.16
|
| Rate for Payer: Blue Shield of California Commercial |
$10.24
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.02
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Central Health Plan Commercial |
$10.22
|
| Rate for Payer: Cigna of CA HMO |
$8.94
|
| Rate for Payer: Cigna of CA HMO |
$9.74
|
| Rate for Payer: Cigna of CA PPO |
$8.94
|
| Rate for Payer: Cigna of CA PPO |
$9.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.83
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Networks By Design Commercial |
$6.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
|
IP
|
$1.38
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
|
|
ATROPINE 0.5 MG/5 ML OR 0.1 MG/1 ML SYRINGE - CODE [4080579]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| 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 Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.55
|
| Rate for Payer: Riverside University Health System MISP |
$0.55
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.17
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.16
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
NDC 0065081701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.44
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: Riverside University Health System MISP |
$5.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.25
|
| Rate for Payer: United Healthcare All Other HMO |
$7.25
|
| Rate for Payer: United Healthcare HMO Rider |
$7.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
NDC 0065081701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.64
|
| Rate for Payer: Blue Shield of California EPN |
$7.31
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
OP
|
$20.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.41 |
| Rate for Payer: Adventist Health Commercial |
$4.09
|
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$13.66
|
| Rate for Payer: Blue Shield of California Commercial |
$12.97
|
| Rate for Payer: Blue Shield of California EPN |
$8.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.16
|
| Rate for Payer: Blue Shield of California EPN |
$8.71
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Central Health Plan Commercial |
$17.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.37
|
| Rate for Payer: Central Health Plan Commercial |
$17.46
|
| Rate for Payer: Cigna of CA HMO |
$15.27
|
| Rate for Payer: Cigna of CA HMO |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$15.08
|
| Rate for Payer: Cigna of CA PPO |
$15.08
|
| Rate for Payer: Cigna of CA PPO |
$15.27
|
| Rate for Payer: Cigna of CA PPO |
$14.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Senior |
$8.73
|
| Rate for Payer: Galaxy Health WC |
$17.39
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Galaxy Health WC |
$18.55
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.28
|
| Rate for Payer: Global Benefits Group Commercial |
$13.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.32
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Multiplan Commercial |
$16.16
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$18.55
|
| Rate for Payer: Prime Health Services Commercial |
$17.39
|
| Rate for Payer: Riverside University Health System MISP |
$8.18
|
| Rate for Payer: Riverside University Health System MISP |
$8.62
|
| Rate for Payer: Riverside University Health System MISP |
$8.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Other HMO |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.47
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7.70
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.31
|
| Rate for Payer: Vantage Medical Group Senior |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$17.39
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
IP
|
$21.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Adventist Health Commercial |
$4.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.50
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California Commercial |
$16.41
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Blue Shield of California EPN |
$10.86
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Central Health Plan Commercial |
$17.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.37
|
| Rate for Payer: Central Health Plan Commercial |
$17.46
|
| Rate for Payer: Cigna of CA HMO |
$15.27
|
| Rate for Payer: Cigna of CA HMO |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$15.08
|
| Rate for Payer: Cigna of CA PPO |
$15.27
|
| Rate for Payer: Cigna of CA PPO |
$15.08
|
| Rate for Payer: Cigna of CA PPO |
$14.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Senior |
$8.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8.73
|
| Rate for Payer: Galaxy Health WC |
$18.31
|
| Rate for Payer: Galaxy Health WC |
$17.39
|
| Rate for Payer: Galaxy Health WC |
$18.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.09
|
| Rate for Payer: Global Benefits Group Commercial |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: Multiplan Commercial |
$16.16
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$18.55
|
| Rate for Payer: Prime Health Services Commercial |
$17.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7.97
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.70
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
|
|
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
|
$27,467.00
|
|
|
Service Code
|
CPT 20936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,069.82 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$55,430.50
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$35,008.74 |
| Max. Negotiated Rate |
$55,430.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$35,008.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,718.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55,430.50
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$65,668.64
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$41,474.93 |
| Max. Negotiated Rate |
$65,668.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$41,474.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49,424.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65,668.64
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$123,705.50
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$78,129.79 |
| Max. Negotiated Rate |
$123,705.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$78,129.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93,104.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123,705.50
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$81,139.63
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$51,246.08 |
| Max. Negotiated Rate |
$81,139.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$51,246.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61,068.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81,139.63
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$158,516.00
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$82,684.31 |
| Max. Negotiated Rate |
$158,516.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156,063.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100,810.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141,138.72
|
| Rate for Payer: CareMore Health Medicare Advantage |
$82,684.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$136,429.11
|
| Rate for Payer: EPIC Health Plan Senior |
$90,952.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,244.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$158,516.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,684.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,758.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$110,796.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$82,684.31
|
| Rate for Payer: Prime Health Services Medicare |
$87,645.37
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$158,516.00
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$75,824.14 |
| Max. Negotiated Rate |
$158,516.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127,339.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82,255.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115,161.22
|
| Rate for Payer: CareMore Health Medicare Advantage |
$75,824.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,109.83
|
| Rate for Payer: EPIC Health Plan Senior |
$83,406.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,244.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$158,516.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,824.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106,153.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101,604.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75,824.14
|
| Rate for Payer: Prime Health Services Medicare |
$80,373.59
|
|
|
AVACINCAPTAD PEGOL (PF) 2 MG/0.1 ML INTRAVITREAL SOLUTION [239150]
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
HCPCS J2782
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$22,680.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$103.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.32
|
| Rate for Payer: Blue Shield of California Commercial |
$138.60
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,160.00
|
| Rate for Payer: Cigna of CA HMO |
$17,640.00
|
| Rate for Payer: Cigna of CA PPO |
$17,640.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.28
|
| Rate for Payer: EPIC Health Plan Senior |
$113.52
|
| Rate for Payer: Galaxy Health WC |
$21,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,680.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$169.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,002.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.29
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: Networks By Design Commercial |
$12,600.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$103.20
|
| Rate for Payer: Prime Health Services Commercial |
$21,420.00
|
| Rate for Payer: Prime Health Services Medicare |
$109.39
|
| Rate for Payer: Riverside University Health System MISP |
$113.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,457.56
|
| Rate for Payer: United Healthcare All Other HMO |
$9,205.56
|
| Rate for Payer: United Healthcare HMO Rider |
$9,006.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,253.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$103.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.52
|
| Rate for Payer: Vantage Medical Group Senior |
$113.52
|
|
|
AVACINCAPTAD PEGOL (PF) 2 MG/0.1 ML INTRAVITREAL SOLUTION [239150]
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
HCPCS J2782
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,040.00 |
| Max. Negotiated Rate |
$22,680.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,210.40
|
| Rate for Payer: Blue Shield of California EPN |
$12,700.80
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,160.00
|
| Rate for Payer: Cigna of CA HMO |
$17,640.00
|
| Rate for Payer: Cigna of CA PPO |
$17,640.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,080.00
|
| Rate for Payer: Galaxy Health WC |
$21,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,680.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,002.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,868.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.00
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: Networks By Design Commercial |
$12,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,457.56
|
| Rate for Payer: United Healthcare All Other HMO |
$9,205.56
|
| Rate for Payer: United Healthcare HMO Rider |
$9,006.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,253.00
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION [232506]
|
Facility
|
OP
|
$2,431.75
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.94 |
| Max. Negotiated Rate |
$2,188.57 |
| Rate for Payer: Adventist Health Commercial |
$486.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$83.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$482.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.36
|
| Rate for Payer: Blue Shield of California Commercial |
$97.92
|
| Rate for Payer: Blue Shield of California EPN |
$89.02
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Central Health Plan Commercial |
$1,945.40
|
| Rate for Payer: Cigna of CA HMO |
$1,702.22
|
| Rate for Payer: Cigna of CA PPO |
$1,702.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,702.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.52
|
| Rate for Payer: EPIC Health Plan Senior |
$92.34
|
| Rate for Payer: Galaxy Health WC |
$2,066.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,188.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$137.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,544.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.49
|
| Rate for Payer: Multiplan Commercial |
$1,823.81
|
| Rate for Payer: Networks By Design Commercial |
$1,215.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$83.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,066.99
|
| Rate for Payer: Prime Health Services Medicare |
$88.99
|
| Rate for Payer: Riverside University Health System MISP |
$92.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$912.64
|
| Rate for Payer: United Healthcare All Other HMO |
$888.32
|
| Rate for Payer: United Healthcare HMO Rider |
$869.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$796.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$83.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION [232506]
|
Facility
|
IP
|
$2,431.75
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$486.35 |
| Max. Negotiated Rate |
$2,188.57 |
| Rate for Payer: Adventist Health Commercial |
$486.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,950.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,225.60
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Central Health Plan Commercial |
$1,945.40
|
| Rate for Payer: Cigna of CA HMO |
$1,702.22
|
| Rate for Payer: Cigna of CA PPO |
$1,702.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,702.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.70
|
| Rate for Payer: EPIC Health Plan Senior |
$972.70
|
| Rate for Payer: Galaxy Health WC |
$2,066.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,188.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,544.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,434.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.35
|
| Rate for Payer: Multiplan Commercial |
$1,823.81
|
| Rate for Payer: Networks By Design Commercial |
$1,215.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,066.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$912.64
|
| Rate for Payer: United Healthcare All Other HMO |
$888.32
|
| Rate for Payer: United Healthcare HMO Rider |
$869.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$796.40
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206411030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,542.17 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,040.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$829.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.37
|
| Rate for Payer: Blue Shield of California EPN |
$683.69
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,370.82
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
| Rate for Payer: Riverside University Health System MISP |
$685.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,028.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.76
|
| Rate for Payer: United Healthcare All Other HMO |
$856.76
|
| Rate for Payer: United Healthcare HMO Rider |
$856.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206411030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,542.17 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.24
|
| Rate for Payer: Blue Shield of California EPN |
$863.61
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,370.82
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.70
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
|
