|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$20,453.50
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$16,335.89 |
| Max. Negotiated Rate |
$20,453.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,335.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,453.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,300.50
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$15,129.40
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$12,083.61 |
| Max. Negotiated Rate |
$15,129.40 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,083.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,129.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,536.83
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$44,296.56
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$35,378.96 |
| Max. Negotiated Rate |
$44,296.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,378.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,296.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,633.77
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$12,290.59
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$9,816.30 |
| Max. Negotiated Rate |
$12,290.59 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,816.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,290.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,996.84
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$102,277.07
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$102,277.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,428.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,277.07
|
| Rate for Payer: EPIC Health Plan Senior |
$68,184.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,986.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,780.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,061.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.84
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
IP
|
$788.02
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$669.82 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Blue Shield of California Commercial |
$399.53
|
| Rate for Payer: Blue Shield of California Commercial |
$605.99
|
| Rate for Payer: Cash Price |
$354.61
|
| Rate for Payer: Cigna of CA HMO |
$551.61
|
| Rate for Payer: Cigna of CA PPO |
$551.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.21
|
| Rate for Payer: EPIC Health Plan Senior |
$315.21
|
| Rate for Payer: Galaxy Health WC |
$669.82
|
| Rate for Payer: Global Benefits Group Commercial |
$472.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.12
|
| Rate for Payer: Multiplan Commercial |
$630.42
|
| Rate for Payer: Networks By Design Commercial |
$394.01
|
| Rate for Payer: Prime Health Services Commercial |
$669.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.08
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
OP
|
$788.02
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$2,180.42 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,180.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$669.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.63
|
| Rate for Payer: Blue Shield of California Commercial |
$368.98
|
| Rate for Payer: Cash Price |
$354.61
|
| Rate for Payer: Cash Price |
$354.61
|
| Rate for Payer: Cigna of CA HMO |
$551.61
|
| Rate for Payer: Cigna of CA PPO |
$551.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$669.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$669.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$669.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.21
|
| Rate for Payer: EPIC Health Plan Senior |
$315.21
|
| Rate for Payer: Galaxy Health WC |
$669.82
|
| Rate for Payer: Global Benefits Group Commercial |
$472.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$559.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$551.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$551.61
|
| Rate for Payer: Multiplan Commercial |
$630.42
|
| Rate for Payer: Networks By Design Commercial |
$394.01
|
| Rate for Payer: Prime Health Services Commercial |
$669.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$669.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$669.82
|
| Rate for Payer: Vantage Medical Group Senior |
$669.82
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.32
|
| Rate for Payer: EPIC Health Plan Senior |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$2.65
|
| Rate for Payer: Cigna of CA PPO |
$2.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$2.65
|
| Rate for Payer: Cigna of CA PPO |
$2.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
OP
|
$66.96
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$53.57
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.13
|
| Rate for Payer: United Healthcare All Other HMO |
$24.46
|
| Rate for Payer: United Healthcare HMO Rider |
$23.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.92
|
| Rate for Payer: Vantage Medical Group Senior |
$56.92
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
IP
|
$66.96
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California Commercial |
$33.95
|
| Rate for Payer: Blue Shield of California Commercial |
$51.49
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$53.57
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.13
|
| Rate for Payer: United Healthcare All Other HMO |
$24.46
|
| Rate for Payer: United Healthcare HMO Rider |
$23.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.93
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5022818201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6068781101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6068781101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 5107907401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| 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 |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 5107907401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5011139803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6068781111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6068781111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 5107907420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| 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 |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5011139801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
