|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION [40446]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 6668973505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION [40446]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
NDC 7288810020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
|
|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION [40446]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 6050504045
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION [40446]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 6668973505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
|
|
ARIPIPRAZOLE 2 MG TABLET [70306]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 6233209730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
ARIPIPRAZOLE 2 MG TABLET [70306]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 6233209730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
|
|
ARIPIPRAZOLE 2 MG TABLET [70306]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 6787743003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
|
|
ARIPIPRAZOLE 2 MG TABLET [70306]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 6787743003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
ARIPIPRAZOLE 5 MG TABLET [36438]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 6233209830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
ARIPIPRAZOLE 5 MG TABLET [36438]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5026808811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
ARIPIPRAZOLE 5 MG TABLET [36438]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5026808811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
ARIPIPRAZOLE 5 MG TABLET [36438]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5026808815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
ARIPIPRAZOLE 5 MG TABLET [36438]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5026808815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
ARIPIPRAZOLE 5 MG TABLET [36438]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 6233209830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION [29071]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$9.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.30
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.06
|
| Rate for Payer: Heritage Provider Network Senior |
$21.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.37
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$34.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION [29071]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$9.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$34.36
|
| Rate for Payer: Blue Shield of California Commercial |
$34.36
|
| Rate for Payer: Blue Shield of California EPN |
$34.36
|
| Rate for Payer: Blue Shield of California EPN |
$34.36
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$21.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$34.12
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.67
|
| Rate for Payer: Vantage Medical Group Senior |
$38.67
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION [220455]
|
Facility
|
IP
|
$279.25
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.54 |
| Max. Negotiated Rate |
$209.44 |
| Rate for Payer: Adventist Health Commercial |
$55.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.84
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.29
|
| Rate for Payer: Heritage Provider Network Senior |
$129.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.81
|
| Rate for Payer: Multiplan Commercial |
$209.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.46
|
|
|
ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION [220455]
|
Facility
|
OP
|
$279.25
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Adventist Health Commercial |
$55.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$172.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$34.36
|
| Rate for Payer: Blue Shield of California EPN |
$34.36
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.29
|
| Rate for Payer: Heritage Provider Network Senior |
$129.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$195.47
|
| Rate for Payer: Multiplan Commercial |
$209.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.70
|
| Rate for Payer: TriValley Medical Group Senior |
$111.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.36
|
| Rate for Payer: Vantage Medical Group Senior |
$237.36
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET [96948]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0078056845
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.34
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET [96948]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0078056845
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Vantage Medical Group Senior |
$5.73
|
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.73
|
|
|
ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Senior |
$210.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$325.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$188.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,001.00
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,061.05 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
ARTESUNATE 110 MG INTRAVENOUS SOLUTION [230847]
|
Facility
|
IP
|
$6,454.20
|
|
|
Service Code
|
HCPCS J0391
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,168.21 |
| Max. Negotiated Rate |
$4,840.65 |
| Rate for Payer: Adventist Health Commercial |
$1,290.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,156.50
|
| Rate for Payer: Cash Price |
$2,904.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,968.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,485.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,988.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,988.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,168.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.55
|
| Rate for Payer: Multiplan Commercial |
$4,840.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,331.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,136.99
|
|
|
ARTESUNATE 110 MG INTRAVENOUS SOLUTION [230847]
|
Facility
|
OP
|
$6,454.20
|
|
|
Service Code
|
HCPCS J0391
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$4,840.65 |
| Rate for Payer: Adventist Health Commercial |
$1,290.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,988.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.83
|
| Rate for Payer: Blue Shield of California Commercial |
$46.18
|
| Rate for Payer: Blue Shield of California EPN |
$46.18
|
| Rate for Payer: Cash Price |
$2,904.39
|
| Rate for Payer: Cash Price |
$2,904.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,968.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,130.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,988.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,988.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,078.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,168.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69.45
|
| Rate for Payer: Multiplan Commercial |
$4,840.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,581.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,581.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,331.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,136.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.01
|
| Rate for Payer: Vantage Medical Group Senior |
$57.01
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
