|
BOTULISM IMMUNE GLOBULIN, HUMAN 100 MG INTRAVENOUS SOLUTION [213747]
|
Facility
IP
|
$271,800.00
|
|
|
Service Code
|
NDC 68403-1100-6
|
| Hospital Charge Code |
NDG213747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$244,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$203,850.00
|
| Rate for Payer: Blue Shield of California EPN |
$145,141.20
|
| Rate for Payer: Cash Price |
$122,310.00
|
| Rate for Payer: Cash Price |
$122,310.00
|
| Rate for Payer: Central Health Plan Commercial |
$217,440.00
|
| Rate for Payer: Cigna of CA HMO |
$190,260.00
|
| Rate for Payer: Cigna of CA PPO |
$190,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$108,720.00
|
| Rate for Payer: Galaxy Health WC |
$231,030.00
|
| Rate for Payer: Global Benefits Group Commercial |
$163,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$244,620.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181,290.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54,360.00
|
| Rate for Payer: Multiplan Commercial |
$203,850.00
|
| Rate for Payer: Networks By Design Commercial |
$135,900.00
|
| Rate for Payer: Prime Health Services Commercial |
$231,030.00
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1324
|
| Min. Negotiated Rate |
$13,400.64 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,400.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,969.10
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1322
|
| Min. Negotiated Rate |
$5,007.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,007.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,967.72
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 608
|
| 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
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1321
|
| Min. Negotiated Rate |
$3,813.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,813.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$4,544.87
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1323
|
| Min. Negotiated Rate |
$8,411.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,411.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,024.06
|
|
|
BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0561
|
| Min. Negotiated Rate |
$5,905.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,905.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,036.86
|
|
|
BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0564
|
| Min. Negotiated Rate |
$18,585.49 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,585.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$22,147.71
|
|
|
BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0563
|
| Min. Negotiated Rate |
$11,604.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,604.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$13,828.13
|
|
|
BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0562
|
| Min. Negotiated Rate |
$8,427.48 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,427.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,042.75
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 584
|
| 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
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 585
|
| 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
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
IP
|
$36,862.13
|
|
|
Service Code
|
APR-DRG 3634
|
| Min. Negotiated Rate |
$30,933.25 |
| Max. Negotiated Rate |
$36,862.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,933.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$36,862.13
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$10,422.35 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,422.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$12,419.96
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3632
|
| Min. Negotiated Rate |
$19,185.85 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,185.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$22,863.14
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3633
|
| Min. Negotiated Rate |
$24,350.54 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,350.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$29,017.73
|
|
|
Breast reduction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,147.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,139.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$8,147.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,999.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,147.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,362.18
|
| Rate for Payer: IEHP medi-cal |
$13,443.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Innovage PACE Commercial |
$12,221.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,147.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,917.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,917.88
|
| Rate for Payer: Multiplan WC |
$11,139.02
|
| Rate for Payer: Preferred Health Network WC |
$11,366.35
|
| Rate for Payer: Prime Health Services Medicare |
$8,636.53
|
| Rate for Payer: Prime Health Services WC |
$11,025.36
|
| Rate for Payer: Riverside University Health MISP |
$8,962.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION [153071]
|
Facility
IP
|
$13,053.60
|
|
|
Service Code
|
NDC 51144-050-01
|
| Hospital Charge Code |
1755786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,610.72 |
| 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 |
$9,790.20
|
| Rate for Payer: Blue Shield of California EPN |
$6,970.62
|
| Rate for Payer: Cash Price |
$5,874.12
|
| Rate for Payer: Cash Price |
$5,874.12
|
| Rate for Payer: Central Health Plan Commercial |
$10,442.88
|
| Rate for Payer: Cigna of CA HMO |
$9,137.52
|
| Rate for Payer: Cigna of CA PPO |
$9,137.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,221.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,221.44
|
| Rate for Payer: Galaxy Health WC |
$11,095.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7,832.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,748.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,706.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,610.72
|
| Rate for Payer: Multiplan Commercial |
$9,790.20
|
| Rate for Payer: Networks By Design Commercial |
$6,526.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,095.56
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION [153071]
|
Facility
OP
|
$13,053.60
|
|
|
Service Code
|
NDC 51144-050-01
|
| Hospital Charge Code |
1755786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,610.72 |
| Max. Negotiated Rate |
$11,748.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,927.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,095.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,179.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,179.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,320.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,712.07
|
| Rate for Payer: BCBS Transplant Transplant |
$7,832.16
|
| Rate for Payer: Blue Shield of California Commercial |
$8,210.71
|
| Rate for Payer: Blue Shield of California EPN |
$6,383.21
|
| Rate for Payer: Cash Price |
$5,874.12
|
| Rate for Payer: Cash Price |
$5,874.12
|
| Rate for Payer: Central Health Plan Commercial |
$10,442.88
|
| Rate for Payer: Cigna of CA HMO |
$9,137.52
|
| Rate for Payer: Cigna of CA PPO |
$9,137.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,095.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,221.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,221.44
|
| Rate for Payer: Galaxy Health WC |
$11,095.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7,832.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,748.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,790.20
|
| Rate for Payer: IEHP medi-cal |
$4,568.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,706.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,610.72
|
| Rate for Payer: Multiplan Commercial |
$9,790.20
|
| Rate for Payer: Networks By Design Commercial |
$6,526.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,095.56
|
| Rate for Payer: Riverside University Health MISP |
$5,221.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,832.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,832.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,526.80
|
| Rate for Payer: United Healthcare All Other HMO |
$6,526.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6,526.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,526.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,095.56
|
| Rate for Payer: Vantage Medical Group Senior |
$11,095.56
|
|
|
BRIMONIDINE 0.15 % EYE DROPS [31158]
|
Facility
OP
|
$36.80
|
|
|
Service Code
|
NDC 61314-144-05
|
| Hospital Charge Code |
1740307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.74
|
| Rate for Payer: BCBS Transplant Transplant |
$22.08
|
| Rate for Payer: Blue Shield of California Commercial |
$23.15
|
| Rate for Payer: Blue Shield of California EPN |
$18.00
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Central Health Plan Commercial |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$25.76
|
| Rate for Payer: Cigna of CA PPO |
$25.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.72
|
| Rate for Payer: Galaxy Health WC |
$31.28
|
| Rate for Payer: Global Benefits Group Commercial |
$22.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.60
|
| Rate for Payer: IEHP medi-cal |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$27.60
|
| Rate for Payer: Networks By Design Commercial |
$23.92
|
| Rate for Payer: Prime Health Services Commercial |
$31.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.08
|
| Rate for Payer: Riverside University Health MISP |
$14.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO |
$18.40
|
| Rate for Payer: United Healthcare HMO Rider |
$18.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.28
|
| Rate for Payer: Vantage Medical Group Senior |
$31.28
|
|
|
BRIMONIDINE 0.15 % EYE DROPS [31158]
|
Facility
IP
|
$36.80
|
|
|
Service Code
|
NDC 61314-144-05
|
| Hospital Charge Code |
1740307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.36 |
| 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 |
$27.60
|
| Rate for Payer: Blue Shield of California EPN |
$19.65
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Central Health Plan Commercial |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$25.76
|
| Rate for Payer: Cigna of CA PPO |
$25.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.72
|
| Rate for Payer: Galaxy Health WC |
$31.28
|
| Rate for Payer: Global Benefits Group Commercial |
$22.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$27.60
|
| Rate for Payer: Networks By Design Commercial |
$23.92
|
| Rate for Payer: Prime Health Services Commercial |
$31.28
|
|
|
BRIMONIDINE 0.15 % EYE DROPS [31158]
|
Facility
OP
|
$49.75
|
|
|
Service Code
|
NDC 0023-9177-05
|
| Hospital Charge Code |
1740307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$44.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$42.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.39
|
| Rate for Payer: BCBS Transplant Transplant |
$29.85
|
| Rate for Payer: Blue Shield of California Commercial |
$31.29
|
| Rate for Payer: Blue Shield of California EPN |
$24.33
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Central Health Plan Commercial |
$39.80
|
| Rate for Payer: Cigna of CA HMO |
$34.82
|
| Rate for Payer: Cigna of CA PPO |
$34.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.90
|
| Rate for Payer: Galaxy Health WC |
$42.29
|
| Rate for Payer: Global Benefits Group Commercial |
$29.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.31
|
| Rate for Payer: IEHP medi-cal |
$17.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.95
|
| Rate for Payer: Multiplan Commercial |
$37.31
|
| Rate for Payer: Networks By Design Commercial |
$32.34
|
| Rate for Payer: Prime Health Services Commercial |
$42.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29.85
|
| Rate for Payer: Riverside University Health MISP |
$19.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.88
|
| Rate for Payer: United Healthcare All Other HMO |
$24.88
|
| Rate for Payer: United Healthcare HMO Rider |
$24.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.29
|
| Rate for Payer: Vantage Medical Group Senior |
$42.29
|
|
|
BRIMONIDINE 0.15 % EYE DROPS [31158]
|
Facility
IP
|
$49.75
|
|
|
Service Code
|
NDC 0023-9177-05
|
| Hospital Charge Code |
1740307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.95 |
| 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 |
$37.31
|
| Rate for Payer: Blue Shield of California EPN |
$26.57
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Central Health Plan Commercial |
$39.80
|
| Rate for Payer: Cigna of CA HMO |
$34.82
|
| Rate for Payer: Cigna of CA PPO |
$34.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.90
|
| Rate for Payer: Galaxy Health WC |
$42.29
|
| Rate for Payer: Global Benefits Group Commercial |
$29.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.95
|
| Rate for Payer: Multiplan Commercial |
$37.31
|
| Rate for Payer: Networks By Design Commercial |
$32.34
|
| Rate for Payer: Prime Health Services Commercial |
$42.29
|
|
|
BRIMONIDINE 0.2 % EYE DROPS [17881]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 70069-232-01
|
| Hospital Charge Code |
NDG17881B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: IEHP medi-cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
BRIMONIDINE 0.2 % EYE DROPS [17881]
|
Facility
IP
|
$3.53
|
|
|
Service Code
|
NDC 17478-715-10
|
| Hospital Charge Code |
NDG17881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| 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 |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.82
|
| Rate for Payer: Cigna of CA HMO |
$2.47
|
| Rate for Payer: Cigna of CA PPO |
$2.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: Galaxy Health WC |
$3.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Prime Health Services Commercial |
$3.00
|
|
