|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 4161648583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 1672902310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 4733548583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 4733548583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 4161648583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS A4706
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$36.81 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS A4706
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
IP
|
$168.64
|
|
|
Service Code
|
NDC 6195825011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$151.78 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Blue Shield of California Commercial |
$135.25
|
| Rate for Payer: Blue Shield of California EPN |
$84.99
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Central Health Plan Commercial |
$134.91
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.73
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
IP
|
$168.64
|
|
|
Service Code
|
NDC 6195825013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$151.78 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Blue Shield of California Commercial |
$135.25
|
| Rate for Payer: Blue Shield of California EPN |
$84.99
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Central Health Plan Commercial |
$134.91
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.73
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
OP
|
$168.64
|
|
|
Service Code
|
NDC 6195825013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$151.78 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.10
|
| Rate for Payer: Blue Shield of California Commercial |
$106.92
|
| Rate for Payer: Blue Shield of California EPN |
$67.29
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Central Health Plan Commercial |
$134.91
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.05
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
| Rate for Payer: Riverside University Health System MISP |
$67.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.32
|
| Rate for Payer: United Healthcare HMO Rider |
$84.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.34
|
| Rate for Payer: Vantage Medical Group Senior |
$143.34
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
OP
|
$168.64
|
|
|
Service Code
|
NDC 6195825011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$151.78 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.10
|
| Rate for Payer: Blue Shield of California Commercial |
$106.92
|
| Rate for Payer: Blue Shield of California EPN |
$67.29
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Central Health Plan Commercial |
$134.91
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.05
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
| Rate for Payer: Riverside University Health System MISP |
$67.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.32
|
| Rate for Payer: United Healthcare HMO Rider |
$84.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.34
|
| Rate for Payer: Vantage Medical Group Senior |
$143.34
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$141,085.63
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$45,279.00 |
| Max. Negotiated Rate |
$141,085.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141,085.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91,135.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127,593.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$127,173.90
|
| Rate for Payer: EPIC Health Plan Senior |
$84,782.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77,075.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107,905.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103,280.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$77,075.09
|
| Rate for Payer: Prime Health Services Medicare |
$81,699.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64,494.00
|
| Rate for Payer: United Healthcare HMO Rider |
$49,424.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45,279.00
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$70,008.54
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$36,596.00 |
| Max. Negotiated Rate |
$70,008.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70,008.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,222.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63,313.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$62,020.96
|
| Rate for Payer: EPIC Health Plan Senior |
$41,347.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,588.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52,623.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50,368.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37,588.46
|
| Rate for Payer: Prime Health Services Medicare |
$39,843.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$52,127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$52,127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,944.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36,596.00
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$57,304.36
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$57,304.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,304.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37,016.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51,824.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,036.18
|
| Rate for Payer: EPIC Health Plan Senior |
$34,024.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,931.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,303.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,447.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,931.02
|
| Rate for Payer: Prime Health Services Medicare |
$32,786.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$93,843.03
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$93,843.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$93,843.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60,618.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84,868.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$82,629.56
|
| Rate for Payer: EPIC Health Plan Senior |
$55,086.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,078.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70,109.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67,105.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$50,078.52
|
| Rate for Payer: Prime Health Services Medicare |
$53,083.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$41,786.68
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$41,786.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,786.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,992.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,790.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,618.75
|
| Rate for Payer: EPIC Health Plan Senior |
$25,079.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,799.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,918.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,550.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,799.24
|
| Rate for Payer: Prime Health Services Medicare |
$24,167.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BIMATOPROST 0.01 % EYE DROPS [105410]
|
Facility
|
OP
|
$129.36
|
|
|
Service Code
|
NDC 0023320503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$116.42 |
| Rate for Payer: Adventist Health Commercial |
$25.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.25
|
| Rate for Payer: Blue Shield of California Commercial |
$82.01
|
| Rate for Payer: Blue Shield of California EPN |
$51.61
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Central Health Plan Commercial |
$103.49
|
| Rate for Payer: Cigna of CA HMO |
$90.55
|
| Rate for Payer: Cigna of CA PPO |
$90.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.74
|
| Rate for Payer: EPIC Health Plan Senior |
$51.74
|
| Rate for Payer: Galaxy Health WC |
$109.96
|
| Rate for Payer: Global Benefits Group Commercial |
$77.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.55
|
| Rate for Payer: Multiplan Commercial |
$97.02
|
| Rate for Payer: Networks By Design Commercial |
$84.08
|
| Rate for Payer: Prime Health Services Commercial |
$109.96
|
| Rate for Payer: Riverside University Health System MISP |
$51.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Other HMO |
$64.68
|
| Rate for Payer: United Healthcare HMO Rider |
$64.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.96
|
| Rate for Payer: Vantage Medical Group Senior |
$109.96
|
|
|
BIMATOPROST 0.01 % EYE DROPS [105410]
|
Facility
|
IP
|
$129.36
|
|
|
Service Code
|
NDC 0023320503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$116.42 |
| Rate for Payer: Adventist Health Commercial |
$25.87
|
| Rate for Payer: Blue Shield of California Commercial |
$103.75
|
| Rate for Payer: Blue Shield of California EPN |
$65.20
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Central Health Plan Commercial |
$103.49
|
| Rate for Payer: Cigna of CA HMO |
$90.55
|
| Rate for Payer: Cigna of CA PPO |
$90.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.74
|
| Rate for Payer: EPIC Health Plan Senior |
$51.74
|
| Rate for Payer: Galaxy Health WC |
$109.96
|
| Rate for Payer: Global Benefits Group Commercial |
$77.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.87
|
| Rate for Payer: Multiplan Commercial |
$97.02
|
| Rate for Payer: Networks By Design Commercial |
$84.08
|
| Rate for Payer: Prime Health Services Commercial |
$109.96
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$64,723.68
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$64,723.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,723.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,808.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58,533.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,451.33
|
| Rate for Payer: EPIC Health Plan Senior |
$38,300.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,818.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,746.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,657.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,818.99
|
| Rate for Payer: Prime Health Services Medicare |
$36,908.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
