|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
NDC 0378647016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 6923816622
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
NDC 0378647097
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.16
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4580258001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$8.54
|
|
|
Service Code
|
NDC 6923816622
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.48
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$5.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO |
$4.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Vantage Medical Group Senior |
$7.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$19.39
|
|
|
Service Code
|
NDC 0378647099
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.83
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cigna of CA HMO |
$13.57
|
| Rate for Payer: Cigna of CA PPO |
$13.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.76
|
| Rate for Payer: EPIC Health Plan Senior |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$16.48
|
| Rate for Payer: Global Benefits Group Commercial |
$11.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$15.51
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$16.48
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
NDC 0378647016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.16
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 6923816621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 4580258084
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
NDC 0378647097
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4580258084
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 4285815091
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$8.54
|
|
|
Service Code
|
NDC 6923816621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.48
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$5.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO |
$4.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Vantage Medical Group Senior |
$7.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4285815091
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 4580258001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
SCROTOPLASTY; SIMPLE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 55175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.56 |
| 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 |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION [91185]
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$319.41
|
| Rate for Payer: Blue Shield of California Commercial |
$484.47
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$371.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.44
|
| Rate for Payer: United Healthcare All Other HMO |
$230.14
|
| Rate for Payer: United Healthcare HMO Rider |
$225.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.32
|
|
|
SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION [91185]
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$39.38
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.30
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.62
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.44
|
| Rate for Payer: United Healthcare All Other HMO |
$230.14
|
| Rate for Payer: United Healthcare HMO Rider |
$225.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.30
|
| Rate for Payer: Vantage Medical Group Senior |
$47.30
|
|
|
SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION [239838]
|
Facility
|
IP
|
$538.72
|
|
|
Service Code
|
HCPCS J3247
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.74 |
| Max. Negotiated Rate |
$457.91 |
| Rate for Payer: Adventist Health Commercial |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$273.13
|
| Rate for Payer: Blue Shield of California Commercial |
$414.28
|
| Rate for Payer: Cash Price |
$242.42
|
| Rate for Payer: Cigna of CA HMO |
$377.10
|
| Rate for Payer: Cigna of CA PPO |
$377.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$377.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.49
|
| Rate for Payer: EPIC Health Plan Senior |
$215.49
|
| Rate for Payer: Galaxy Health WC |
$457.91
|
| Rate for Payer: Global Benefits Group Commercial |
$323.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$317.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.29
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Networks By Design Commercial |
$269.36
|
| Rate for Payer: Prime Health Services Commercial |
$457.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.18
|
| Rate for Payer: United Healthcare All Other HMO |
$196.79
|
| Rate for Payer: United Healthcare HMO Rider |
$192.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.43
|
|
|
SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION [239838]
|
Facility
|
OP
|
$538.72
|
|
|
Service Code
|
HCPCS J3247
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$457.91 |
| Rate for Payer: Adventist Health Commercial |
$107.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.22
|
| Rate for Payer: Blue Shield of California Commercial |
$20.51
|
| Rate for Payer: Cash Price |
$242.42
|
| Rate for Payer: Cash Price |
$242.42
|
| Rate for Payer: Cigna of CA HMO |
$377.10
|
| Rate for Payer: Cigna of CA PPO |
$377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$377.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$457.91
|
| Rate for Payer: Global Benefits Group Commercial |
$323.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.43
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Networks By Design Commercial |
$269.36
|
| Rate for Payer: Prime Health Services Commercial |
$457.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.18
|
| Rate for Payer: United Healthcare All Other HMO |
$196.79
|
| Rate for Payer: United Healthcare HMO Rider |
$192.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
SEIZURE
|
Facility
|
IP
|
$54,800.58
|
|
|
Service Code
|
APR-DRG 0534
|
| Min. Negotiated Rate |
$43,768.36 |
| Max. Negotiated Rate |
$54,800.58 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,768.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54,800.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,032.10
|
|
|
SEIZURE
|
Facility
|
IP
|
$10,033.69
|
|
|
Service Code
|
APR-DRG 0531
|
| Min. Negotiated Rate |
$8,013.75 |
| Max. Negotiated Rate |
$10,033.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,013.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,033.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,977.51
|
|
|
SEIZURE
|
Facility
|
IP
|
$22,424.88
|
|
|
Service Code
|
APR-DRG 0533
|
| Min. Negotiated Rate |
$17,910.40 |
| Max. Negotiated Rate |
$22,424.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,910.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,424.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,064.37
|
|
|
SEIZURE
|
Facility
|
IP
|
$14,085.23
|
|
|
Service Code
|
APR-DRG 0532
|
| Min. Negotiated Rate |
$11,249.65 |
| Max. Negotiated Rate |
$14,085.23 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,249.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,085.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,602.58
|
|
|
SEIZURES WITH MCC
|
Facility
|
IP
|
$113,617.80
|
|
|
Service Code
|
MSDRG 100
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$113,617.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,716.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$113,617.80
|
| Rate for Payer: EPIC Health Plan Senior |
$75,745.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,859.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,402.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92,271.42
|
| 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
|
|
