|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Senior |
$58.38
|
| Rate for Payer: Dignity Health Senior |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.52
|
| Rate for Payer: Humana Medicare |
$53.08
|
| Rate for Payer: Humana Medicare |
$53.08
|
| Rate for Payer: IEHP Medi-Cal |
$82.80
|
| Rate for Payer: IEHP Medi-Cal |
$82.80
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.88
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.38
|
| Rate for Payer: TriValley Medical Group Senior |
$53.08
|
| Rate for Payer: TriValley Medical Group Senior |
$53.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| 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 Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
1770007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.38
|
| Rate for Payer: Dignity Health Senior |
$58.38
|
| Rate for Payer: Dignity Health Senior |
$58.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.52
|
| Rate for Payer: Humana Medicare |
$53.08
|
| Rate for Payer: Humana Medicare |
$53.08
|
| Rate for Payer: IEHP Medi-Cal |
$82.80
|
| Rate for Payer: IEHP Medi-Cal |
$82.80
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: IEHP Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.88
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.38
|
| Rate for Payer: TriValley Medical Group Senior |
$53.08
|
| Rate for Payer: TriValley Medical Group Senior |
$53.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.62
|
| 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 Medi-Cal |
$58.38
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: 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 |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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
|
$0.28
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| 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 |
$0.13
|
| 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: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| 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: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| 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 |
$0.06
|
| 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 |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: AlphaCare 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 |
$0.17
|
| 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 |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$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: Cigna of CA HMO/PPO |
$0.13
|
| 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 |
$0.18
|
| 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: 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: 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 |
$0.05
|
| 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: 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 |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| 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 % 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
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 % 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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: 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 |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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 % INTRAVENOUS SOLUTION [8982]
|
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: Adventist Health Commercial |
$0.09
|
| 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 |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: AlphaCare 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 |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| 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 |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: 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 |
$0.08
|
| 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 |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| 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
|
$0.43
|
|
|
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 |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| 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 |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.29
|
| 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: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| 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 |
$0.16
|
| 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
|
$0.22
|
|
|
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 |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: AlphaCare 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 |
$0.14
|
| 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: 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 |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: 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 |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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
IP
|
$0.22
|
|
|
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 |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| 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 |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: 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 |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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
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 |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| 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 |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: 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 |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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
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 |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.16
|
| 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 |
$0.13
|
| 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: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| 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 |
$0.19
|
| 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 |
$0.05
|
| 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 |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| 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 |
$0.13
|
| 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+ |
$0.07
|
| 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 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 |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: AlphaCare 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 |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| 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: 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 |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| 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: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: 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 |
$0.09
|
| 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 |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: AlphaCare 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 |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| 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 |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| 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 |
$0.16
|
| 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 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 |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| 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 |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medi-Cal |
$16.57
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: IEHP Medicare Advantage |
$10.62
|
| Rate for Payer: 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 |
$0.04
|
| 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: 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 |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: TriValley Medical Group Senior |
$10.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| 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+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| 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-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: AlphaCare Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.38
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$82.80
|
| Rate for Payer: 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 |
$58.38
|
| Rate for Payer: TriValley Medical Group Senior |
$53.08
|
| 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
|
|
|
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
|
|
