|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
ERX219902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Adventist Health Commercial |
$62.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$166.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$233.58
|
| Rate for Payer: Blue Shield of California Commercial |
$193.40
|
| Rate for Payer: Blue Shield of California EPN |
$182.82
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$202.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.72
|
| Rate for Payer: Dignity Health Senior |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.78
|
| Rate for Payer: Heritage Provider Network Senior |
$192.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.86
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
ERX219902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$233.58 |
| Rate for Payer: Adventist Health Commercial |
$62.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.96
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.84
|
| Rate for Payer: Heritage Provider Network Senior |
$210.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.86
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
OP
|
$108.87
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
1712538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Adventist Health Commercial |
$21.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.65
|
| Rate for Payer: Blue Shield of California Commercial |
$67.61
|
| Rate for Payer: Blue Shield of California EPN |
$63.91
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.54
|
| Rate for Payer: Dignity Health Senior |
$92.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.39
|
| Rate for Payer: Heritage Provider Network Senior |
$67.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.22
|
| Rate for Payer: Multiplan Commercial |
$81.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.54
|
| Rate for Payer: Vantage Medical Group Senior |
$92.54
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
IP
|
$108.87
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
1712538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Adventist Health Commercial |
$21.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.79
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.70
|
| Rate for Payer: Heritage Provider Network Senior |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.22
|
| Rate for Payer: Multiplan Commercial |
$81.65
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 30802
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$127.78
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,620.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,095.98
|
| Rate for Payer: TriValley Medical Group Senior |
$1,905.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 30801
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$89.43
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,620.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,095.98
|
| Rate for Payer: TriValley Medical Group Senior |
$1,905.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency
|
Facility
OP
|
$31,243.54
|
|
|
Service Code
|
CPT 20982
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$31,243.54 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Dignity Health Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,443.97
|
| Rate for Payer: Humana Medicare |
$16,443.97
|
| Rate for Payer: IEHP Medi-Cal |
$5,737.88
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,243.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,403.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,719.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,088.37
|
| Rate for Payer: TriValley Medical Group Senior |
$16,443.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
OP
|
$618.60
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX106761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$463.95 |
| Rate for Payer: Adventist Health Commercial |
$123.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$424.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California EPN |
$8.76
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Senior |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.41
|
| Rate for Payer: Heritage Provider Network Senior |
$286.41
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: IEHP Medi-Cal |
$19.81
|
| Rate for Payer: IEHP Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$463.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.69
|
| Rate for Payer: TriValley Medical Group Senior |
$8.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
IP
|
$618.60
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX106761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.97 |
| Max. Negotiated Rate |
$463.95 |
| Rate for Payer: Adventist Health Commercial |
$123.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$424.98
|
| Rate for Payer: Cash Price |
$278.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.79
|
| Rate for Payer: Heritage Provider Network Senior |
$418.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.65
|
| Rate for Payer: Multiplan Commercial |
$463.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.67
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
IP
|
$1,030.80
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX99465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.57 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$206.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$708.16
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$474.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$697.85
|
| Rate for Payer: Heritage Provider Network Senior |
$697.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.70
|
| Rate for Payer: Multiplan Commercial |
$773.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$375.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$344.39
|
|
|
ABOBOTULINUMTOXINA 500 UNIT INTRAMUSCULAR SOLUTION [99465]
|
Facility
OP
|
$1,030.80
|
|
|
Service Code
|
CPT J0586
|
| Hospital Charge Code |
ERX99465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$206.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$708.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California EPN |
$8.76
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$474.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Senior |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.26
|
| Rate for Payer: Heritage Provider Network Senior |
$477.26
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: IEHP Medi-Cal |
$19.81
|
| Rate for Payer: IEHP Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$773.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.69
|
| Rate for Payer: TriValley Medical Group Senior |
$8.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$375.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$344.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$22,322.19
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$22,322.19 |
| Max. Negotiated Rate |
$22,322.19 |
| Rate for Payer: IEHP Medi-Cal |
$22,322.19
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$5,528.64
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$5,528.64 |
| Max. Negotiated Rate |
$5,528.64 |
| Rate for Payer: IEHP Medi-Cal |
$5,528.64
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$4,176.58
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$4,176.58 |
| Max. Negotiated Rate |
$4,176.58 |
| Rate for Payer: IEHP Medi-Cal |
$4,176.58
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$7,475.65
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$7,475.65 |
| Max. Negotiated Rate |
$7,475.65 |
| Rate for Payer: IEHP Medi-Cal |
$7,475.65
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$3,567.69
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$3,567.69 |
| Max. Negotiated Rate |
$3,567.69 |
| Rate for Payer: IEHP Medi-Cal |
$3,567.69
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$2,667.32
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$2,667.32 |
| Max. Negotiated Rate |
$2,667.32 |
| Rate for Payer: IEHP Medi-Cal |
$2,667.32
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$14,413.05
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$14,413.05 |
| Max. Negotiated Rate |
$14,413.05 |
| Rate for Payer: IEHP Medi-Cal |
$14,413.05
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$4,980.45
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$4,980.45 |
| Max. Negotiated Rate |
$4,980.45 |
| Rate for Payer: IEHP Medi-Cal |
$4,980.45
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
1711694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
1711694
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Senior |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
1753544
|
|
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 |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| 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 |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
1753544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: IEHP Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| 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 |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
IP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.17
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
OP
|
$1.70
|
|
|
Service Code
|
CPT J0131
|
| Hospital Charge Code |
NDG108021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: Dignity Health Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: IEHP Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
