|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.56
|
| Rate for Payer: Heritage Provider Network Senior |
$59.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.98
|
| Rate for Payer: Blue Shield of California Commercial |
$53.66
|
| Rate for Payer: Blue Shield of California EPN |
$42.93
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.77
|
| Rate for Payer: Dignity Health Senior |
$74.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.45
|
| Rate for Payer: Heritage Provider Network Senior |
$54.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.58
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.19
|
| Rate for Payer: TriValley Medical Group Senior |
$35.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.77
|
| Rate for Payer: Vantage Medical Group Senior |
$74.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$60.62 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.72
|
| Rate for Payer: Heritage Provider Network Senior |
$54.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Blue Shield of California Commercial |
$49.31
|
| Rate for Payer: Blue Shield of California EPN |
$39.45
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Senior |
$68.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.03
|
| Rate for Payer: Heritage Provider Network Senior |
$50.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Senior |
$32.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Blue Shield of California Commercial |
$49.31
|
| Rate for Payer: Blue Shield of California EPN |
$39.45
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Senior |
$68.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.03
|
| Rate for Payer: Heritage Provider Network Senior |
$50.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Senior |
$32.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-02
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.44
|
| Rate for Payer: Heritage Provider Network Senior |
$109.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$115.75 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.49
|
| Rate for Payer: Heritage Provider Network Senior |
$104.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.59
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$131.19 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Blue Shield of California Commercial |
$94.15
|
| Rate for Payer: Blue Shield of California EPN |
$75.32
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Senior |
$131.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.54
|
| Rate for Payer: Heritage Provider Network Senior |
$95.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.04
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.74
|
| Rate for Payer: TriValley Medical Group Senior |
$61.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$77.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.52
|
| Rate for Payer: Heritage Provider Network Senior |
$99.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Blue Shield of California Commercial |
$89.67
|
| Rate for Payer: Blue Shield of California EPN |
$71.74
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Senior |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Senior |
$90.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.52
|
| Rate for Payer: Heritage Provider Network Senior |
$99.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 0143-9392-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Blue Shield of California Commercial |
$89.67
|
| Rate for Payer: Blue Shield of California EPN |
$71.74
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Senior |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Senior |
$90.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-05
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$115.75 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.49
|
| Rate for Payer: Heritage Provider Network Senior |
$104.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.59
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$137.41 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Blue Shield of California Commercial |
$98.61
|
| Rate for Payer: Blue Shield of California EPN |
$78.89
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Senior |
$137.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.07
|
| Rate for Payer: Heritage Provider Network Senior |
$100.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.66
|
| Rate for Payer: TriValley Medical Group Senior |
$64.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$80.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.44
|
| Rate for Payer: Heritage Provider Network Senior |
$109.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$154.34
|
|
|
Service Code
|
NDC 63323-724-05
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$131.19 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Blue Shield of California Commercial |
$94.15
|
| Rate for Payer: Blue Shield of California EPN |
$75.32
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Senior |
$131.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.54
|
| Rate for Payer: Heritage Provider Network Senior |
$95.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.04
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.74
|
| Rate for Payer: TriValley Medical Group Senior |
$61.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$77.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$161.66
|
|
|
Service Code
|
NDC 72078-035-02
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$137.41 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Blue Shield of California Commercial |
$98.61
|
| Rate for Payer: Blue Shield of California EPN |
$78.89
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Senior |
$137.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.07
|
| Rate for Payer: Heritage Provider Network Senior |
$100.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.66
|
| Rate for Payer: TriValley Medical Group Senior |
$64.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$80.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Senior |
$0.23
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
OP
|
$884.58
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$663.43 |
| Rate for Payer: Adventist Health Commercial |
$176.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$472.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.36
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$29.49
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$406.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.98
|
| Rate for Payer: Dignity Health Senior |
$32.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$409.56
|
| Rate for Payer: Heritage Provider Network Senior |
$409.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$421.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.78
|
| Rate for Payer: Multiplan Commercial |
$663.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$353.83
|
| Rate for Payer: TriValley Medical Group Senior |
$353.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$319.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$292.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.98
|
| Rate for Payer: Vantage Medical Group Senior |
$32.98
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
IP
|
$884.58
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$663.43 |
| Rate for Payer: Adventist Health Commercial |
$176.92
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$406.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$409.56
|
| Rate for Payer: Heritage Provider Network Senior |
$409.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.15
|
| Rate for Payer: Multiplan Commercial |
$663.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$319.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$292.88
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
|
IP
|
$102.09
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$76.57 |
| Rate for Payer: Adventist Health Commercial |
$20.42
|
| Rate for Payer: Adventist Health Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.27
|
| Rate for Payer: Heritage Provider Network Senior |
$47.27
|
| Rate for Payer: Heritage Provider Network Senior |
$42.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.52
|
| Rate for Payer: Multiplan Commercial |
$69.61
|
| Rate for Payer: Multiplan Commercial |
$76.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.80
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
|
OP
|
$92.81
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Adventist Health Commercial |
$18.56
|
| Rate for Payer: Adventist Health Commercial |
$20.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.70
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.89
|
| Rate for Payer: Dignity Health Senior |
$86.78
|
| Rate for Payer: Dignity Health Senior |
$78.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.27
|
| Rate for Payer: Heritage Provider Network Senior |
$47.27
|
| Rate for Payer: Heritage Provider Network Senior |
$42.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.97
|
| Rate for Payer: Multiplan Commercial |
$69.61
|
| Rate for Payer: Multiplan Commercial |
$76.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.84
|
| Rate for Payer: TriValley Medical Group Senior |
$40.84
|
| Rate for Payer: TriValley Medical Group Senior |
$37.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.89
|
| Rate for Payer: Vantage Medical Group Senior |
$86.78
|
| Rate for Payer: Vantage Medical Group Senior |
$78.89
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]
|
Facility
|
OP
|
$508.62
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$381.46 |
| Rate for Payer: Adventist Health Commercial |
$101.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$271.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.05
|
| Rate for Payer: Blue Shield of California Commercial |
$36.71
|
| Rate for Payer: Blue Shield of California EPN |
$36.71
|
| Rate for Payer: Cash Price |
$279.74
|
| Rate for Payer: Cash Price |
$279.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.85
|
| Rate for Payer: Dignity Health Senior |
$33.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.49
|
| Rate for Payer: Heritage Provider Network Senior |
$235.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.77
|
| Rate for Payer: Multiplan Commercial |
$381.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$203.45
|
| Rate for Payer: TriValley Medical Group Senior |
$203.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.85
|
| Rate for Payer: Vantage Medical Group Senior |
$33.85
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]
|
Facility
|
IP
|
$508.62
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.06 |
| Max. Negotiated Rate |
$381.46 |
| Rate for Payer: Adventist Health Commercial |
$101.72
|
| Rate for Payer: Cash Price |
$279.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.49
|
| Rate for Payer: Heritage Provider Network Senior |
$235.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.16
|
| Rate for Payer: Multiplan Commercial |
$381.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.40
|
|
