|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
IP
|
$75,746.26
|
|
|
Service Code
|
APR-DRG 1833
|
| Min. Negotiated Rate |
$58,105.35 |
| Max. Negotiated Rate |
$75,746.26 |
| Rate for Payer: IEHP Medi-Cal |
$58,105.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75,746.26
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
IP
|
$107,828.14
|
|
|
Service Code
|
APR-DRG 1834
|
| Min. Negotiated Rate |
$82,715.53 |
| Max. Negotiated Rate |
$107,828.14 |
| Rate for Payer: IEHP Medi-Cal |
$82,715.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107,828.14
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
IP
|
$63,239.81
|
|
|
Service Code
|
APR-DRG 1831
|
| Min. Negotiated Rate |
$48,511.59 |
| Max. Negotiated Rate |
$63,239.81 |
| Rate for Payer: IEHP Medi-Cal |
$48,511.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,239.81
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
IP
|
$65,052.30
|
|
|
Service Code
|
APR-DRG 1832
|
| Min. Negotiated Rate |
$49,901.96 |
| Max. Negotiated Rate |
$65,052.30 |
| Rate for Payer: IEHP Medi-Cal |
$49,901.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65,052.30
|
|
|
PERFLUTREN PROTEIN-TYPE A MICROSPHERES 0.22 MG/ML INTRAVENOUS SUSP [82177]
|
Facility
IP
|
$56.16
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
NDG82177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Blue Shield of California Commercial |
$39.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.75
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.46
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.48
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
|
|
PERFLUTREN PROTEIN-TYPE A MICROSPHERES 0.22 MG/ML INTRAVENOUS SUSP [82177]
|
Facility
OP
|
$56.16
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
NDG82177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$265.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$265.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.04
|
| Rate for Payer: BCBS Transplant Transplant |
$33.70
|
| Rate for Payer: Blue Shield of California Commercial |
$41.39
|
| Rate for Payer: Blue Shield of California EPN |
$32.80
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$39.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.74
|
| Rate for Payer: Dignity Health Media |
$47.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.46
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.48
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.08
|
| Rate for Payer: United Healthcare All Other HMO |
$28.08
|
| Rate for Payer: United Healthcare HMO Rider |
$28.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.74
|
| Rate for Payer: Vantage Medical Group Senior |
$47.74
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
IP
|
$13,818.80
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$10,600.47 |
| Max. Negotiated Rate |
$13,818.80 |
| Rate for Payer: IEHP Medi-Cal |
$10,600.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,818.80
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
IP
|
$9,993.45
|
|
|
Service Code
|
APR-DRG 1972
|
| Min. Negotiated Rate |
$7,666.03 |
| Max. Negotiated Rate |
$9,993.45 |
| Rate for Payer: IEHP Medi-Cal |
$7,666.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,993.45
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
IP
|
$25,183.13
|
|
|
Service Code
|
APR-DRG 1974
|
| Min. Negotiated Rate |
$19,318.11 |
| Max. Negotiated Rate |
$25,183.13 |
| Rate for Payer: IEHP Medi-Cal |
$19,318.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,183.13
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
IP
|
$7,482.22
|
|
|
Service Code
|
APR-DRG 1971
|
| Min. Negotiated Rate |
$5,739.65 |
| Max. Negotiated Rate |
$7,482.22 |
| Rate for Payer: IEHP Medi-Cal |
$5,739.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,482.22
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$11,006.09
|
|
|
Service Code
|
APR-DRG 0482
|
| Min. Negotiated Rate |
$8,442.83 |
| Max. Negotiated Rate |
$11,006.09 |
| Rate for Payer: IEHP Medi-Cal |
$8,442.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,006.09
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$27,696.13
|
|
|
Service Code
|
APR-DRG 0484
|
| Min. Negotiated Rate |
$21,245.85 |
| Max. Negotiated Rate |
$27,696.13 |
| Rate for Payer: IEHP Medi-Cal |
$21,245.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,696.13
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$9,557.17
|
|
|
Service Code
|
APR-DRG 0481
|
| Min. Negotiated Rate |
$7,331.36 |
| Max. Negotiated Rate |
$9,557.17 |
| Rate for Payer: IEHP Medi-Cal |
$7,331.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,557.17
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$14,937.86
|
|
|
Service Code
|
APR-DRG 0483
|
| Min. Negotiated Rate |
$11,458.91 |
| Max. Negotiated Rate |
$14,937.86 |
| Rate for Payer: IEHP Medi-Cal |
$11,458.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,937.86
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0941-0413-07
|
| Hospital Charge Code |
NDG27801A
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0941-0413-07
|
| Hospital Charge Code |
NDG27801A
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0941-0413-04
|
| Hospital Charge Code |
NDG27801
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0941-0413-01
|
| Hospital Charge Code |
1771281
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0941-0413-01
|
| Hospital Charge Code |
1771281
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 0941-0413-05
|
| Hospital Charge Code |
1771149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0941-0413-04
|
| Hospital Charge Code |
NDG27801
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 0941-0413-05
|
| Hospital Charge Code |
1771149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0941-0415-06
|
| Hospital Charge Code |
1771289
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0941-0415-04
|
| Hospital Charge Code |
NDG27805
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 0941-0415-05
|
| Hospital Charge Code |
1771156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
