|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 7220526906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 7220526906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
OP
|
$30.22
|
|
|
Service Code
|
NDC 5047457066
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Adventist Health Commercial |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.58
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$12.06
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Central Health Plan Commercial |
$24.18
|
| Rate for Payer: Cigna of CA HMO |
$21.15
|
| Rate for Payer: Cigna of CA PPO |
$21.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.09
|
| Rate for Payer: EPIC Health Plan Senior |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$25.69
|
| Rate for Payer: Global Benefits Group Commercial |
$18.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$22.66
|
| Rate for Payer: Networks By Design Commercial |
$19.64
|
| Rate for Payer: Prime Health Services Commercial |
$25.69
|
| Rate for Payer: Riverside University Health System MISP |
$12.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.11
|
| Rate for Payer: United Healthcare All Other HMO |
$15.11
|
| Rate for Payer: United Healthcare HMO Rider |
$15.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.69
|
| Rate for Payer: Vantage Medical Group Senior |
$25.69
|
|
|
BROMFENAC 0.09 % EYE DROPS [41146]
|
Facility
|
OP
|
$100.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Adventist Health Commercial |
$20.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.42
|
| Rate for Payer: Blue Shield of California Commercial |
$63.76
|
| Rate for Payer: Blue Shield of California EPN |
$40.12
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Central Health Plan Commercial |
$80.45
|
| Rate for Payer: Cigna of CA HMO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$70.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Senior |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.48
|
| Rate for Payer: Global Benefits Group Commercial |
$60.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.39
|
| Rate for Payer: Multiplan Commercial |
$75.42
|
| Rate for Payer: Networks By Design Commercial |
$50.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.48
|
| Rate for Payer: Riverside University Health System MISP |
$40.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.74
|
| Rate for Payer: United Healthcare All Other HMO |
$36.73
|
| Rate for Payer: United Healthcare HMO Rider |
$35.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.48
|
| Rate for Payer: Vantage Medical Group Senior |
$85.48
|
|
|
BROMFENAC 0.09 % EYE DROPS [41146]
|
Facility
|
IP
|
$100.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Adventist Health Commercial |
$20.11
|
| Rate for Payer: Blue Shield of California Commercial |
$80.65
|
| Rate for Payer: Blue Shield of California EPN |
$50.68
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Central Health Plan Commercial |
$80.45
|
| Rate for Payer: Cigna of CA HMO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$70.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Senior |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.48
|
| Rate for Payer: Global Benefits Group Commercial |
$60.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.11
|
| Rate for Payer: Multiplan Commercial |
$75.42
|
| Rate for Payer: Networks By Design Commercial |
$50.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.74
|
| Rate for Payer: United Healthcare All Other HMO |
$36.73
|
| Rate for Payer: United Healthcare HMO Rider |
$35.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.93
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 0574010603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Central Health Plan Commercial |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 6330496230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Central Health Plan Commercial |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 0574010603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Central Health Plan Commercial |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Riverside University Health System MISP |
$1.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 7095497810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Central Health Plan Commercial |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Riverside University Health System MISP |
$1.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 7095497820
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 6330496230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Central Health Plan Commercial |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Riverside University Health System MISP |
$1.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 7095497820
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 7095497810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Central Health Plan Commercial |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$13,251.36
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$8,369.28 |
| Max. Negotiated Rate |
$13,251.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,369.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,973.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,251.36
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$25,000.12
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$15,789.55 |
| Max. Negotiated Rate |
$25,000.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,789.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,815.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,000.12
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$7,281.29
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$4,598.71 |
| Max. Negotiated Rate |
$7,281.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,598.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,480.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,281.29
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$4,588.33
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$2,897.89 |
| Max. Negotiated Rate |
$4,588.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,897.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,453.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,588.33
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$25,561.01
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,561.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,561.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,511.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,116.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,589.13
|
| Rate for Payer: EPIC Health Plan Senior |
$15,726.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,296.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,015.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,157.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,296.44
|
| Rate for Payer: Prime Health Services Medicare |
$15,154.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$17,633.73
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$17,633.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,633.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,390.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,947.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,734.76
|
| Rate for Payer: EPIC Health Plan Senior |
$11,156.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,142.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,199.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,590.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,142.28
|
| Rate for Payer: Prime Health Services Medicare |
$10,750.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$283.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,289.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| 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: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$283.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$366.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,289.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$366.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$346.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,289.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S])
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31627
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.00 |
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,859.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,054.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,510.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$7,464.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,510.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,668.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Preferred Health Network WC |
$7,616.47
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), ONE OR TWO MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,422.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$7,464.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,422.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,571.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Preferred Health Network WC |
$7,616.47
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
