|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$48,304.31
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$38,579.89 |
| Max. Negotiated Rate |
$48,304.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38,579.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48,304.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,219.64
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$8,160.20
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$6,517.42 |
| Max. Negotiated Rate |
$8,160.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,517.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,160.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,301.23
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 7857300081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 7857300081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 26340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.29 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$385.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,895.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J2151
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J2151
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION [4750]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS J2151
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION [4750]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
HCPCS J2151
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$113,436.77
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$113,436.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,406.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$113,436.77
|
| Rate for Payer: EPIC Health Plan Senior |
$75,624.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,749.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,249.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92,124.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$109,848.80
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$109,848.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,276.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,848.80
|
| Rate for Payer: EPIC Health Plan Senior |
$73,232.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,575.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93,205.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,210.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$88,388.70
|
|
|
Service Code
|
APR-DRG 3624
|
| Min. Negotiated Rate |
$70,594.66 |
| Max. Negotiated Rate |
$88,388.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70,594.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88,388.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,084.63
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$44,265.15
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$35,353.88 |
| Max. Negotiated Rate |
$44,265.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,353.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,265.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,605.67
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$44,849.77
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$35,820.80 |
| Max. Negotiated Rate |
$44,849.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,820.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,849.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,128.74
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$28,379.84
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$22,666.53 |
| Max. Negotiated Rate |
$28,379.84 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,666.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,379.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,392.49
|
|
|
MASTOPEXY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 19316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,540.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,394.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,540.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,091.61
|
| Rate for Payer: EPIC Health Plan Senior |
$9,394.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,006.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$154.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,956.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,760.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,444.10
|
| Rate for Payer: Multiplan WC |
$13,202.52
|
| Rate for Payer: Prime Health Services WC |
$13,067.80
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,540.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,540.37
|
|
|
MC MICROCATH PHENOM
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.43 |
| Max. Negotiated Rate |
$4,239.80 |
| Rate for Payer: Adventist Health Commercial |
$997.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,239.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,743.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,741.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,200.80
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Cigna of CA HMO |
$3,192.32
|
| Rate for Payer: Cigna of CA PPO |
$3,691.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,239.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,239.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,239.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,995.20
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,167.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,810.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,942.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,491.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,491.60
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,992.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,992.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,494.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,494.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,494.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,239.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,239.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,239.80
|
|
|
MC MICROCATH PHENOM
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.60 |
| Max. Negotiated Rate |
$4,239.80 |
| Rate for Payer: Adventist Health Commercial |
$997.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,995.20
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,167.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,942.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.12
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [10512]
|
Facility
|
IP
|
$114.89
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$97.66 |
| Rate for Payer: Adventist Health Commercial |
$22.98
|
| Rate for Payer: Blue Shield of California Commercial |
$58.25
|
| Rate for Payer: Blue Shield of California Commercial |
$88.35
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO |
$80.42
|
| Rate for Payer: Cigna of CA PPO |
$80.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.96
|
| Rate for Payer: EPIC Health Plan Senior |
$45.96
|
| Rate for Payer: Galaxy Health WC |
$97.66
|
| Rate for Payer: Global Benefits Group Commercial |
$68.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.57
|
| Rate for Payer: Multiplan Commercial |
$91.91
|
| Rate for Payer: Networks By Design Commercial |
$57.45
|
| Rate for Payer: Prime Health Services Commercial |
$97.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.12
|
| Rate for Payer: United Healthcare All Other HMO |
$41.97
|
| Rate for Payer: United Healthcare HMO Rider |
$41.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.63
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [10512]
|
Facility
|
OP
|
$114.89
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$696.19 |
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO |
$80.42
|
| Rate for Payer: Cigna of CA PPO |
$80.42
|
| Rate for Payer: Adventist Health Commercial |
$22.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$696.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.74
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.96
|
| Rate for Payer: EPIC Health Plan Senior |
$45.96
|
| Rate for Payer: Galaxy Health WC |
$97.66
|
| Rate for Payer: Global Benefits Group Commercial |
$68.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.42
|
| Rate for Payer: Multiplan Commercial |
$91.91
|
| Rate for Payer: Networks By Design Commercial |
$57.45
|
| Rate for Payer: Prime Health Services Commercial |
$97.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.12
|
| Rate for Payer: United Healthcare All Other HMO |
$41.97
|
| Rate for Payer: United Healthcare HMO Rider |
$41.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.66
|
| Rate for Payer: Vantage Medical Group Senior |
$97.66
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 5026852215
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 5026852211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 5026852215
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
