|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$57,752.72
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$57,752.72 |
| Max. Negotiated Rate |
$57,752.72 |
| Rate for Payer: IEHP Medi-Cal |
$57,752.72
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$34,310.97
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$34,310.97 |
| Max. Negotiated Rate |
$34,310.97 |
| Rate for Payer: IEHP Medi-Cal |
$34,310.97
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$42,110.96
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$42,110.96 |
| Max. Negotiated Rate |
$42,110.96 |
| Rate for Payer: IEHP Medi-Cal |
$42,110.96
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
IP
|
$30,275.68
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$30,275.68 |
| Max. Negotiated Rate |
$30,275.68 |
| Rate for Payer: IEHP Medi-Cal |
$30,275.68
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
IP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$359.64 |
| Rate for Payer: Adventist Health Commercial |
$95.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.43
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.64
|
| Rate for Payer: Heritage Provider Network Senior |
$324.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.88
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.21
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
IP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-02
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$359.64 |
| Rate for Payer: Adventist Health Commercial |
$95.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.43
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.64
|
| Rate for Payer: Heritage Provider Network Senior |
$324.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.88
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.21
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
OP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-02
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Adventist Health Commercial |
$95.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$256.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$359.64
|
| Rate for Payer: Blue Shield of California Commercial |
$297.78
|
| Rate for Payer: Blue Shield of California EPN |
$281.48
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.59
|
| Rate for Payer: Dignity Health Senior |
$407.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.02
|
| Rate for Payer: Heritage Provider Network Senior |
$222.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$231.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.88
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.59
|
| Rate for Payer: Vantage Medical Group Senior |
$407.59
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
OP
|
$479.52
|
|
|
Service Code
|
NDC 68727-800-01
|
| Hospital Charge Code |
NDG4081463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Adventist Health Commercial |
$95.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$256.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$407.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$263.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$359.64
|
| Rate for Payer: Blue Shield of California Commercial |
$297.78
|
| Rate for Payer: Blue Shield of California EPN |
$281.48
|
| Rate for Payer: Cash Price |
$215.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.59
|
| Rate for Payer: Dignity Health Senior |
$407.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.02
|
| Rate for Payer: Heritage Provider Network Senior |
$222.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$231.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.88
|
| Rate for Payer: Multiplan Commercial |
$359.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.59
|
| Rate for Payer: Vantage Medical Group Senior |
$407.59
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$17,667.36
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$17,667.36 |
| Max. Negotiated Rate |
$17,667.36 |
| Rate for Payer: IEHP Medi-Cal |
$17,667.36
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$5,810.19
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$5,810.19 |
| Max. Negotiated Rate |
$5,810.19 |
| Rate for Payer: IEHP Medi-Cal |
$5,810.19
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$9,922.10
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$9,922.10 |
| Max. Negotiated Rate |
$9,922.10 |
| Rate for Payer: IEHP Medi-Cal |
$9,922.10
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
IP
|
$7,374.16
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$7,374.16 |
| Max. Negotiated Rate |
$7,374.16 |
| Rate for Payer: IEHP Medi-Cal |
$7,374.16
|
|
|
Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15630
|
| Min. Negotiated Rate |
$78.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$78.98
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,278.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15620
|
| Min. Negotiated Rate |
$394.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$394.93
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,278.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.72
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.63
|
| Rate for Payer: Heritage Provider Network Senior |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: Dignity Health Senior |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.15
|
| Rate for Payer: Heritage Provider Network Senior |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: Dignity Health Senior |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.15
|
| Rate for Payer: Heritage Provider Network Senior |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.72
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.63
|
| Rate for Payer: Heritage Provider Network Senior |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
IP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.35 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.39
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
OP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California EPN |
$8.88
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.86
|
| Rate for Payer: Dignity Health Senior |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.86
|
| Rate for Payer: Vantage Medical Group Senior |
$12.86
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
IP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$381.79 |
| Max. Negotiated Rate |
$1,582.01 |
| Rate for Payer: Adventist Health Commercial |
$421.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,449.12
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$970.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,139.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,428.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,428.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.34
|
| Rate for Payer: Multiplan Commercial |
$1,582.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$769.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$704.73
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
OP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$1,582.01 |
| Rate for Payer: Adventist Health Commercial |
$421.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,449.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.75
|
| Rate for Payer: Blue Shield of California Commercial |
$24.11
|
| Rate for Payer: Blue Shield of California EPN |
$24.11
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$970.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: Dignity Health Senior |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,349.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.63
|
| Rate for Payer: Heritage Provider Network Senior |
$976.63
|
| Rate for Payer: Humana Medicare |
$25.20
|
| Rate for Payer: IEHP Medi-Cal |
$46.27
|
| Rate for Payer: IEHP Medicare Advantage |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.75
|
| Rate for Payer: Multiplan Commercial |
$1,582.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.72
|
| Rate for Payer: TriValley Medical Group Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$769.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$704.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
OP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$1,462.09 |
| Rate for Payer: Adventist Health Commercial |
$389.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,339.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.75
|
| Rate for Payer: Blue Shield of California Commercial |
$24.11
|
| Rate for Payer: Blue Shield of California EPN |
$24.11
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$896.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: Dignity Health Senior |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,247.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$902.60
|
| Rate for Payer: Heritage Provider Network Senior |
$902.60
|
| Rate for Payer: Humana Medicare |
$25.20
|
| Rate for Payer: IEHP Medi-Cal |
$46.27
|
| Rate for Payer: IEHP Medicare Advantage |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.75
|
| Rate for Payer: Multiplan Commercial |
$1,462.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.72
|
| Rate for Payer: TriValley Medical Group Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$710.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$651.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
IP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$352.85 |
| Max. Negotiated Rate |
$1,462.09 |
| Rate for Payer: Adventist Health Commercial |
$389.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,339.27
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$896.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,052.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,319.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,319.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.36
|
| Rate for Payer: Multiplan Commercial |
$1,462.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$710.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$651.31
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$7,604.98
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$7,604.98 |
| Max. Negotiated Rate |
$7,604.98 |
| Rate for Payer: IEHP Medi-Cal |
$7,604.98
|
|
