|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
OP
|
$209.32
|
|
|
Service Code
|
NDC 55513-206-01
|
| Hospital Charge Code |
NDG225272A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$177.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$115.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.67
|
| Rate for Payer: BCBS Transplant Transplant |
$125.59
|
| Rate for Payer: Blue Shield of California Commercial |
$131.66
|
| Rate for Payer: Blue Shield of California EPN |
$102.36
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$156.99
|
| Rate for Payer: IEHP medi-cal |
$73.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: Riverside University Health MISP |
$83.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.66
|
| Rate for Payer: United Healthcare All Other HMO |
$104.66
|
| Rate for Payer: United Healthcare HMO Rider |
$104.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.92
|
| Rate for Payer: Vantage Medical Group Senior |
$177.92
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
OP
|
$209.32
|
|
|
Service Code
|
NDC 55513-207-01
|
| Hospital Charge Code |
NDG225272B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$177.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$115.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.67
|
| Rate for Payer: BCBS Transplant Transplant |
$125.59
|
| Rate for Payer: Blue Shield of California Commercial |
$131.66
|
| Rate for Payer: Blue Shield of California EPN |
$102.36
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$156.99
|
| Rate for Payer: IEHP medi-cal |
$73.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: Riverside University Health MISP |
$83.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.66
|
| Rate for Payer: United Healthcare All Other HMO |
$104.66
|
| Rate for Payer: United Healthcare HMO Rider |
$104.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.92
|
| Rate for Payer: Vantage Medical Group Senior |
$177.92
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
IP
|
$209.32
|
|
|
Service Code
|
NDC 55513-207-01
|
| Hospital Charge Code |
NDG225272B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$156.99
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT J0565
|
| Hospital Charge Code |
NDG216412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$85.50
|
| Rate for Payer: Blue Shield of California EPN |
$60.88
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT J0565
|
| Hospital Charge Code |
NDG216412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$247.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$39.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.30
|
| Rate for Payer: BCBS Transplant Transplant |
$68.40
|
| Rate for Payer: Blue Shield of California Commercial |
$50.16
|
| Rate for Payer: Blue Shield of California EPN |
$45.60
|
| Rate for Payer: Caremore Medicare Advantage |
$39.86
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.86
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65.37
|
| Rate for Payer: IEHP medi-cal |
$65.77
|
| Rate for Payer: IEHP Medicare Advantage |
$39.86
|
| Rate for Payer: Innovage PACE Commercial |
$59.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.41
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Prime Health Services Medicare |
$42.25
|
| Rate for Payer: Riverside University Health MISP |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Vantage Medical Group Senior |
$39.86
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
OP
|
$0.91
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: BCBS Transplant Transplant |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| 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: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.68
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 41616-485-83
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.40
|
| 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
|
$0.91
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.41
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| 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
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6019-46
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6019-46
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 41616-485-83
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| 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: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| 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: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-111-06
|
| Hospital Charge Code |
1771296
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$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: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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: Riverside University Health 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-111-06
|
| Hospital Charge Code |
1771296
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$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
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
NDG121260
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$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
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
NDG121260
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$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: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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: Riverside University Health 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
CPT A4706
|
| Hospital Charge Code |
NDG120070
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
CPT A4706
|
| Hospital Charge Code |
NDG120070
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$36.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$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: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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: Riverside University Health 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
NDC 24571-105-06
|
| Hospital Charge Code |
1771276
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-105-06
|
| Hospital Charge Code |
1771276
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$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: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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: Riverside University Health 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
OP
|
$151.81
|
|
|
Service Code
|
NDC 61958-2501-1
|
| Hospital Charge Code |
ERX221141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$136.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$129.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$83.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.69
|
| Rate for Payer: BCBS Transplant Transplant |
$91.09
|
| Rate for Payer: Blue Shield of California Commercial |
$95.49
|
| Rate for Payer: Blue Shield of California EPN |
$74.24
|
| Rate for Payer: Cash Price |
$68.31
|
| Rate for Payer: Central Health Plan Commercial |
$121.45
|
| Rate for Payer: Cigna of CA HMO |
$106.27
|
| Rate for Payer: Cigna of CA PPO |
$106.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.72
|
| Rate for Payer: Galaxy Health WC |
$129.04
|
| Rate for Payer: Global Benefits Group Commercial |
$91.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$113.86
|
| Rate for Payer: IEHP medi-cal |
$53.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.36
|
| Rate for Payer: Multiplan Commercial |
$113.86
|
| Rate for Payer: Networks By Design Commercial |
$98.68
|
| Rate for Payer: Prime Health Services Commercial |
$129.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$91.09
|
| Rate for Payer: Riverside University Health MISP |
$60.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.90
|
| Rate for Payer: United Healthcare All Other HMO |
$75.90
|
| Rate for Payer: United Healthcare HMO Rider |
$75.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.04
|
| Rate for Payer: Vantage Medical Group Senior |
$129.04
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
IP
|
$151.81
|
|
|
Service Code
|
NDC 61958-2501-1
|
| Hospital Charge Code |
ERX221141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$113.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.07
|
| Rate for Payer: Cash Price |
$68.31
|
| Rate for Payer: Cash Price |
$68.31
|
| Rate for Payer: Central Health Plan Commercial |
$121.45
|
| Rate for Payer: Cigna of CA HMO |
$106.27
|
| Rate for Payer: Cigna of CA PPO |
$106.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: Galaxy Health WC |
$129.04
|
| Rate for Payer: Global Benefits Group Commercial |
$91.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.36
|
| Rate for Payer: Multiplan Commercial |
$113.86
|
| Rate for Payer: Networks By Design Commercial |
$98.68
|
| Rate for Payer: Prime Health Services Commercial |
$129.04
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 461
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 462
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 409
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 408
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
