|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
NDC 3172293502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$21.49
|
|
|
Service Code
|
NDC 4359845202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.75
|
| Rate for Payer: Blue Shield of California Commercial |
$13.11
|
| Rate for Payer: Blue Shield of California EPN |
$10.49
|
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.30
|
| Rate for Payer: Heritage Provider Network Senior |
$13.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.60
|
| Rate for Payer: TriValley Medical Group Senior |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.27
|
| Rate for Payer: Vantage Medical Group Senior |
$18.27
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| 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 |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| 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: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$79.98 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| 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: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| 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 |
$53.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.32
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| 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/Medicare |
$71.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.45
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Senior |
$0.56
|
| Rate for Payer: TriValley Medical Group Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| 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 |
$79.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]
|
Facility
|
OP
|
$1.38
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$79.98 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.52
|
| 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 |
$0.62
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.52
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$71.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.45
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$0.56
|
| Rate for Payer: TriValley Medical Group Senior |
$0.55
|
| Rate for Payer: TriValley Medical Group Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]
|
Facility
|
IP
|
$1.38
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.62
|
| 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: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| 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: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$79.98 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| 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: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| 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 |
$53.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.32
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.32
|
| 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/Medicare |
$71.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.45
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Senior |
$0.56
|
| Rate for Payer: TriValley Medical Group Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| 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 |
$79.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAP [40805272]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Multiplan Commercial |
$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 |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| 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 |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| 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: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| 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 |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.62
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.23
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| 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 |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| 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: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
|
|
ALBUMIN, HUMAN 5 % CONTINUOUS INTRAVENOUS SOLUTION [4088982]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.51
|
| 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 |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$79.62 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| 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 |
$53.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$53.08
|
| 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 |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| 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/Medicare |
$71.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.13
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| 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 |
$66.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.51
|
| 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 |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
HCPCS P9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| 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 |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.62
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.23
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.93
|
| 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
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$79.62 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| 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 |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.13
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [8982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$79.62 |
| 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 Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$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: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| 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 |
$53.08
|
| 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 |
$0.16
|
| 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 |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| 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/Medicare |
$71.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.13
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| 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 All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Cash Price |
$0.10
|
| 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 |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$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: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| 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 |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.51
|
| 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 |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$0.79
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| 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 |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.62
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.23
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
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 |
$0.16
|
| 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 |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$79.62 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| 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 |
$66.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.39
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.13
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.39
|
| Rate for Payer: Vantage Medical Group Senior |
$58.39
|
|
|
ALBUTEROL SULFATE 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [31577]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0487030101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
|
|
ALBUTEROL SULFATE 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [31577]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487030101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487990401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
