|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$3,430.40
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$3,430.40 |
| Max. Negotiated Rate |
$3,430.40 |
| Rate for Payer: IEHP Medi-Cal |
$3,430.40
|
|
|
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
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$13,309.71
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$13,309.71 |
| Max. Negotiated Rate |
$13,309.71 |
| Rate for Payer: IEHP Medi-Cal |
$13,309.71
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$6,045.98
|
|
|
Service Code
|
APR-DRG 7543
|
| Min. Negotiated Rate |
$6,045.98 |
| Max. Negotiated Rate |
$6,045.98 |
| Rate for Payer: IEHP Medi-Cal |
$6,045.98
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$2,848.39
|
|
|
Service Code
|
APR-DRG 7541
|
| Min. Negotiated Rate |
$2,848.39 |
| Max. Negotiated Rate |
$2,848.39 |
| Rate for Payer: IEHP Medi-Cal |
$2,848.39
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$3,810.46
|
|
|
Service Code
|
APR-DRG 7542
|
| Min. Negotiated Rate |
$3,810.46 |
| Max. Negotiated Rate |
$3,810.46 |
| Rate for Payer: IEHP Medi-Cal |
$3,810.46
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$12,786.40
|
|
|
Service Code
|
APR-DRG 7544
|
| Min. Negotiated Rate |
$12,786.40 |
| Max. Negotiated Rate |
$12,786.40 |
| Rate for Payer: IEHP Medi-Cal |
$12,786.40
|
|
|
Dermabrasion; segmental, face
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15781
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$888.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$263.09
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Dermabrasion; superficial, any site (eg, tattoo removal)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15783
|
| Min. Negotiated Rate |
$235.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$773.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$235.22
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$498.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
1710265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.93
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Senior |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
OP
|
$1.35
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
1710265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.15
|
| Rate for Payer: Dignity Health Senior |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Senior |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.15
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
IP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
1711734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
OP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
1711734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Senior |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
OP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
1711735
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: Dignity Health Senior |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
IP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
1711735
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
OP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
NDG27770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Adventist Health Commercial |
$9.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.46
|
| Rate for Payer: Blue Shield of California Commercial |
$29.36
|
| Rate for Payer: Blue Shield of California EPN |
$27.75
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.19
|
| Rate for Payer: Dignity Health Senior |
$40.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.27
|
| Rate for Payer: Heritage Provider Network Senior |
$29.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.19
|
| Rate for Payer: Vantage Medical Group Senior |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
IP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
NDG27770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$35.46 |
| Rate for Payer: Adventist Health Commercial |
$9.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.48
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.01
|
| Rate for Payer: Heritage Provider Network Senior |
$32.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$35.46
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
IP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
1740263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Adventist Health Commercial |
$5.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.30
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.01
|
| Rate for Payer: Heritage Provider Network Senior |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.39
|
| Rate for Payer: Multiplan Commercial |
$22.16
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
OP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
1740263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Adventist Health Commercial |
$5.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.16
|
| Rate for Payer: Blue Shield of California Commercial |
$18.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.35
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.12
|
| Rate for Payer: Dignity Health Senior |
$25.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.29
|
| Rate for Payer: Heritage Provider Network Senior |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.39
|
| Rate for Payer: Multiplan Commercial |
$22.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.12
|
| Rate for Payer: Vantage Medical Group Senior |
$25.12
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
OP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
1712429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.57
|
| Rate for Payer: Dignity Health Senior |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
IP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
1712429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.07
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
OP
|
$61.20
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1757507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$12.24
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.89
|
| Rate for Payer: Blue Shield of California Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California EPN |
$13.39
|
| Rate for Payer: Blue Shield of California EPN |
$13.39
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.34
|
| Rate for Payer: Heritage Provider Network Senior |
$28.34
|
| Rate for Payer: Heritage Provider Network Senior |
$29.17
|
| Rate for Payer: Humana Medicare |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Senior |
$6.33
|
| Rate for Payer: TriValley Medical Group Senior |
$6.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
OP
|
$71.42
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1720511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$53.56 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Adventist Health Commercial |
$13.92
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.89
|
| Rate for Payer: Blue Shield of California Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California EPN |
$13.39
|
| Rate for Payer: Blue Shield of California EPN |
$13.39
|
| Rate for Payer: Blue Shield of California EPN |
$13.39
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.22
|
| Rate for Payer: Heritage Provider Network Senior |
$33.07
|
| Rate for Payer: Heritage Provider Network Senior |
$29.17
|
| Rate for Payer: Heritage Provider Network Senior |
$32.22
|
| Rate for Payer: Humana Medicare |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Senior |
$6.33
|
| Rate for Payer: TriValley Medical Group Senior |
$6.33
|
| Rate for Payer: TriValley Medical Group Senior |
$6.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
IP
|
$61.20
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1757507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$12.24
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.43
|
| Rate for Payer: Heritage Provider Network Senior |
$41.43
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.45
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
IP
|
$71.42
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1720511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$53.56 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Adventist Health Commercial |
$13.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.07
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.12
|
| Rate for Payer: Heritage Provider Network Senior |
$47.12
|
| Rate for Payer: Heritage Provider Network Senior |
$48.35
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.86
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.86
|
|
