|
Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26502
|
| Min. Negotiated Rate |
$105.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$105.13
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
1796133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$112.75 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$12.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.75
|
| Rate for Payer: Blue Shield of California Commercial |
$65.73
|
| Rate for Payer: Blue Shield of California Commercial |
$65.73
|
| Rate for Payer: Blue Shield of California EPN |
$65.73
|
| Rate for Payer: Blue Shield of California EPN |
$65.73
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.58
|
| Rate for Payer: Dignity Health Senior |
$52.58
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$28.64
|
| Rate for Payer: IEHP Medi-Cal |
$102.35
|
| Rate for Payer: IEHP Medi-Cal |
$102.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.58
|
| Rate for Payer: Vantage Medical Group Senior |
$52.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
IP
|
$7.20
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
1796133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$41.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.67
|
|
|
REHABILITATION
|
Facility
IP
|
$8,608.83
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$8,608.83 |
| Max. Negotiated Rate |
$8,608.83 |
| Rate for Payer: IEHP Medi-Cal |
$8,608.83
|
|
|
REHABILITATION
|
Facility
IP
|
$10,551.87
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$10,551.87 |
| Max. Negotiated Rate |
$10,551.87 |
| Rate for Payer: IEHP Medi-Cal |
$10,551.87
|
|
|
REHABILITATION
|
Facility
IP
|
$13,440.05
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$13,440.05 |
| Max. Negotiated Rate |
$13,440.05 |
| Rate for Payer: IEHP Medi-Cal |
$13,440.05
|
|
|
REHABILITATION
|
Facility
IP
|
$16,464.54
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$16,464.54 |
| Max. Negotiated Rate |
$16,464.54 |
| Rate for Payer: IEHP Medi-Cal |
$16,464.54
|
|
|
Release, intrinsic muscles of hand, each muscle
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26593
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$174.24
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
OP
|
$104.15
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
ERX229912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$88.53 |
| Rate for Payer: Adventist Health Commercial |
$20.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$88.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$78.11
|
| Rate for Payer: Blue Shield of California Commercial |
$64.68
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.53
|
| Rate for Payer: Dignity Health Senior |
$88.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.47
|
| Rate for Payer: Heritage Provider Network Senior |
$64.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.04
|
| Rate for Payer: Multiplan Commercial |
$78.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.53
|
| Rate for Payer: Vantage Medical Group Senior |
$88.53
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
IP
|
$104.15
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
ERX229912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$78.11 |
| Rate for Payer: Adventist Health Commercial |
$20.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.55
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.51
|
| Rate for Payer: Heritage Provider Network Senior |
$70.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.04
|
| Rate for Payer: Multiplan Commercial |
$78.11
|
|
|
REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE) [228088]
|
Facility
IP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.43
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Heritage Provider Network Senior |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.42
|
|
|
REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE) [228088]
|
Facility
OP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$5.30
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: Dignity Health Senior |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.45
|
| Rate for Payer: Heritage Provider Network Senior |
$14.45
|
| Rate for Payer: Humana Medicare |
$6.06
|
| Rate for Payer: IEHP Medi-Cal |
$16.41
|
| Rate for Payer: IEHP Medicare Advantage |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.66
|
| Rate for Payer: TriValley Medical Group Senior |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG/20 ML VIAL - COMMERCIAL PRODUCT [4082058624]
|
Facility
IP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.43
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Heritage Provider Network Senior |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.42
|
|
|
REMDESIVIR 100 MG/20 ML VIAL - COMMERCIAL PRODUCT [4082058624]
|
Facility
OP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$5.30
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: Dignity Health Senior |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.45
|
| Rate for Payer: Heritage Provider Network Senior |
$14.45
|
| Rate for Payer: Humana Medicare |
$6.06
|
| Rate for Payer: IEHP Medi-Cal |
$16.41
|
| Rate for Payer: IEHP Medicare Advantage |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.66
|
| Rate for Payer: TriValley Medical Group Senior |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
OP
|
$685.78
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
ERX4082058626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$514.34 |
| Rate for Payer: Adventist Health Commercial |
$137.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$471.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$5.30
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: Dignity Health Senior |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$317.52
|
| Rate for Payer: Heritage Provider Network Senior |
$317.52
|
| Rate for Payer: Humana Medicare |
$6.06
|
| Rate for Payer: IEHP Medi-Cal |
$16.41
|
| Rate for Payer: IEHP Medicare Advantage |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$514.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.66
|
| Rate for Payer: TriValley Medical Group Senior |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$229.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
IP
|
$685.78
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
ERX4082058626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$514.34 |
| Rate for Payer: Adventist Health Commercial |
$137.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$471.13
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.27
|
| Rate for Payer: Heritage Provider Network Senior |
$464.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.44
|
| Rate for Payer: Multiplan Commercial |
$514.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$229.12
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Adventist Health Commercial |
$15.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.88
|
| Rate for Payer: Blue Shield of California Commercial |
$47.92
|
| Rate for Payer: Blue Shield of California EPN |
$45.30
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.59
|
| Rate for Payer: Dignity Health Senior |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.77
|
| Rate for Payer: Heritage Provider Network Senior |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.29
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$57.88 |
| Rate for Payer: Adventist Health Commercial |
$15.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.02
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.24
|
| Rate for Payer: Heritage Provider Network Senior |
$52.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.29
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Blue Shield of California EPN |
$43.14
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: Dignity Health Senior |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.50
|
| Rate for Payer: Heritage Provider Network Senior |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$55.16 |
| Rate for Payer: Adventist Health Commercial |
$14.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.53
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.79
|
| Rate for Payer: Heritage Provider Network Senior |
$49.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Adventist Health Commercial |
$14.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.16
|
| Rate for Payer: Blue Shield of California Commercial |
$45.67
|
| Rate for Payer: Blue Shield of California EPN |
$43.17
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.52
|
| Rate for Payer: Dignity Health Senior |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.53
|
| Rate for Payer: Heritage Provider Network Senior |
$45.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$55.12 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.49
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.76
|
| Rate for Payer: Heritage Provider Network Senior |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Blue Shield of California EPN |
$43.14
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: Dignity Health Senior |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.50
|
| Rate for Payer: Heritage Provider Network Senior |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-00
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Adventist Health Commercial |
$14.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.16
|
| Rate for Payer: Blue Shield of California Commercial |
$45.67
|
| Rate for Payer: Blue Shield of California EPN |
$43.17
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.52
|
| Rate for Payer: Dignity Health Senior |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.53
|
| Rate for Payer: Heritage Provider Network Senior |
$45.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$57.88 |
| Rate for Payer: Adventist Health Commercial |
$15.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.02
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.24
|
| Rate for Payer: Heritage Provider Network Senior |
$52.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.29
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
|
