|
Pediatric Allo Related/Unrelated Stem Cell Transplant
|
Facility
|
IP
|
$165,432.00
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$165,432.00 |
| Max. Negotiated Rate |
$165,432.00 |
| Rate for Payer: Heritage Provider Network Transplant |
$165,432.00
|
|
|
Pediatric Allo Unrelated BMT
|
Facility
|
OP
|
$151,688.00
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$151,688.00 |
| Max. Negotiated Rate |
$151,688.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$151,688.00
|
|
|
Pediatric Allo Unrelated BMT
|
Facility
|
IP
|
$257,640.00
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$202,250.00 |
| Max. Negotiated Rate |
$257,640.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202,250.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$257,640.00
|
|
|
Pediatric Autologous Transplant - Inpatient
|
Facility
|
IP
|
$158,516.00
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$123,207.00 |
| Max. Negotiated Rate |
$158,516.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140,995.00
|
| Rate for Payer: Blue Distinction Transplant |
$123,207.00
|
| Rate for Payer: Blue Shield of California Transplant |
$125,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$158,516.00
|
| Rate for Payer: Networks By Design Commercial |
$140,000.00
|
|
|
Pediatric Autologous Transplant - Inpatient
|
Facility
|
IP
|
$158,516.00
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$123,207.00 |
| Max. Negotiated Rate |
$158,516.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140,995.00
|
| Rate for Payer: Blue Distinction Transplant |
$123,207.00
|
| Rate for Payer: Blue Shield of California Transplant |
$125,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$158,516.00
|
| Rate for Payer: Networks By Design Commercial |
$140,000.00
|
|
|
Pediatric Autologous Transplant - Outpatient
|
Facility
|
OP
|
$135,000.00
|
|
|
Service Code
|
HCPCS S2150
|
| Min. Negotiated Rate |
$105,746.00 |
| Max. Negotiated Rate |
$135,000.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,746.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135,000.00
|
|
|
Pediatric Autologous Transplant - Outpatient
|
Facility
|
OP
|
$135,000.00
|
|
|
Service Code
|
CPT 38241
|
| Min. Negotiated Rate |
$105,746.00 |
| Max. Negotiated Rate |
$135,000.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,746.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135,000.00
|
|
|
Pediatric Heart Transplant
|
Facility
|
IP
|
$315,618.00
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$128,000.00 |
| Max. Negotiated Rate |
$315,618.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$272,940.00
|
| Rate for Payer: Blue Distinction Transplant |
$293,627.00
|
| Rate for Payer: Blue Shield of California Transplant |
$190,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257,250.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$135,000.00
|
| Rate for Payer: Networks By Design Commercial |
$128,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$315,618.00
|
|
|
Pediatric Heart Transplant
|
Facility
|
IP
|
$315,618.00
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$128,000.00 |
| Max. Negotiated Rate |
$315,618.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$272,940.00
|
| Rate for Payer: Blue Distinction Transplant |
$293,627.00
|
| Rate for Payer: Blue Shield of California Transplant |
$190,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257,250.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$135,000.00
|
| Rate for Payer: Networks By Design Commercial |
$128,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$315,618.00
|
|
|
Pediatric Kidney-Pancreas Transplant
|
Facility
|
IP
|
$192,500.00
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$192,500.00 |
| Max. Negotiated Rate |
$192,500.00 |
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192,500.00
|
|
|
Pediatric Kidney-Pancreas Transplant
|
Facility
|
IP
|
$192,500.00
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$192,500.00 |
| Max. Negotiated Rate |
$192,500.00 |
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192,500.00
|
|
|
Pediatric Kidney Transplant
|
Facility
|
IP
|
$135,871.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$85,000.00 |
| Max. Negotiated Rate |
$135,871.00 |
| Rate for Payer: Blue Distinction Transplant |
$117,902.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119,600.00
|
| Rate for Payer: Networks By Design Commercial |
$85,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$135,871.00
|
|
|
Pediatric Kidney Transplant
|
Facility
|
IP
|
$135,871.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$85,000.00 |
| Max. Negotiated Rate |
$135,871.00 |
| Rate for Payer: Blue Distinction Transplant |
$117,902.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119,600.00
|
| Rate for Payer: Networks By Design Commercial |
$85,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$135,871.00
|
|
|
Pediatric Kidney Transplant
|
Facility
|
IP
|
$135,871.00
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$85,000.00 |
| Max. Negotiated Rate |
$135,871.00 |
| Rate for Payer: Blue Distinction Transplant |
$117,902.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119,600.00
|
| Rate for Payer: Networks By Design Commercial |
$85,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$135,871.00
|
|
|
Pediatric Liver Transplant
|
Facility
|
IP
|
$135,095.00
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$135,095.00 |
| Max. Negotiated Rate |
$135,095.00 |
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$135,095.00
|
|
|
Pediatric Liver Transplant
|
Facility
|
IP
|
$135,095.00
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$135,095.00 |
| Max. Negotiated Rate |
$135,095.00 |
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$135,095.00
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 1650059916
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 1650008619
|
| 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
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068104900
|
| 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: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| 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
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 1650007814
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 1650007818
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 1650059916
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.10
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 1650007818
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068104900
|
| 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| 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 |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 1650008619
|
| 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: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| 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: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| 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 Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
