|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Senior |
$0.29
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: Dignity Health Senior |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| 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: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Senior |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Humana Medicare |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.88
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Senior |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Humana Medicare |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.88
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Senior |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.90
|
| Rate for Payer: Dignity Health Senior |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Senior |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2.90
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.34
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.49
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
|
|
ALBUTEROL SULFATE 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [31577]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0487-0301-01
|
| Hospital Charge Code |
NDG31577
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
|
