|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 6808465411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$1.07
|
| Rate for Payer: Cigna of CA PPO |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Senior |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 6808465411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$1.07
|
| Rate for Payer: Cigna of CA PPO |
$1.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Senior |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.30
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 0378512301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| 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 |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| 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 |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| 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 |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 6050500800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| 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 Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| 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 Senior |
$0.09
|
|
|
SOTALOL ORAL SUSPENSION COMPOUND 5 MG/ML [4080338]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 9994080338
|
| 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
|
|
|
SOTALOL ORAL SUSPENSION COMPOUND 5 MG/ML [4080338]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 9994080338
|
| 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
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
OP
|
$114.18
|
|
|
Service Code
|
NDC 5551348840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.27
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.93
|
| Rate for Payer: Multiplan Commercial |
$91.34
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.09
|
| Rate for Payer: United Healthcare All Other HMO |
$57.09
|
| Rate for Payer: United Healthcare HMO Rider |
$57.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.05
|
| Rate for Payer: Vantage Medical Group Senior |
$97.05
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
IP
|
$114.18
|
|
|
Service Code
|
NDC 5551348824
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Blue Shield of California Commercial |
$57.89
|
| Rate for Payer: Blue Shield of California Commercial |
$87.80
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$91.34
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
IP
|
$114.18
|
|
|
Service Code
|
NDC 5551348840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Blue Shield of California Commercial |
$57.89
|
| Rate for Payer: Blue Shield of California Commercial |
$87.80
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$91.34
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
OP
|
$114.18
|
|
|
Service Code
|
NDC 5551348824
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.27
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.93
|
| Rate for Payer: Multiplan Commercial |
$91.34
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.09
|
| Rate for Payer: United Healthcare All Other HMO |
$57.09
|
| Rate for Payer: United Healthcare HMO Rider |
$57.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.05
|
| Rate for Payer: Vantage Medical Group Senior |
$97.05
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$18,792.08
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$15,008.94 |
| Max. Negotiated Rate |
$18,792.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,008.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,792.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,813.97
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$26,908.77
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$21,491.61 |
| Max. Negotiated Rate |
$26,908.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,491.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,908.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,076.27
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$37,964.87
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$30,321.94 |
| Max. Negotiated Rate |
$37,964.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,964.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,968.57
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$70,221.72
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$56,084.98 |
| Max. Negotiated Rate |
$70,221.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56,084.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70,221.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,829.96
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$111,390.82
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$111,390.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,986.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,390.82
|
| Rate for Payer: EPIC Health Plan Senior |
$74,260.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,509.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,513.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,462.85
|
| 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
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$96,625.34
|
|
|
Service Code
|
MSDRG 053
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,625.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,685.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,625.34
|
| Rate for Payer: EPIC Health Plan Senior |
$64,416.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,560.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,985.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,471.49
|
| 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
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$34,546.88
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$27,592.05 |
| Max. Negotiated Rate |
$34,546.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,592.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,546.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,910.37
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$73,757.13
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$58,908.65 |
| Max. Negotiated Rate |
$73,757.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58,908.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73,757.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65,993.22
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$133,235.14
|
|
|
Service Code
|
APR-DRG 3214
|
| Min. Negotiated Rate |
$106,412.81 |
| Max. Negotiated Rate |
$133,235.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106,412.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133,235.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119,210.39
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$47,114.83
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$37,629.87 |
| Max. Negotiated Rate |
$47,114.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,629.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47,114.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,155.38
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$185,063.77
|
|
|
Service Code
|
MSDRG 457
|
| Min. Negotiated Rate |
$29,434.00 |
| Max. Negotiated Rate |
$185,063.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$180,777.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$185,063.77
|
| Rate for Payer: EPIC Health Plan Senior |
$123,375.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$112,159.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157,023.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150,294.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$90,575.00
|
| Rate for Payer: United Healthcare All Other HMO |
$90,575.00
|
| Rate for Payer: United Healthcare HMO Rider |
$62,293.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57,072.00
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$254,757.47
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$29,434.00 |
| Max. Negotiated Rate |
$254,757.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$254,757.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$228,366.48
|
| Rate for Payer: EPIC Health Plan Senior |
$152,244.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$138,403.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$193,765.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185,461.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,148.00
|
| Rate for Payer: United Healthcare All Other HMO |
$112,148.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75,636.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69,294.00
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$153,291.68
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$29,434.00 |
| Max. Negotiated Rate |
$153,291.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126,496.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$153,291.68
|
| Rate for Payer: EPIC Health Plan Senior |
$102,194.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92,904.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130,065.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124,491.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$81,933.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81,933.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53,969.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,445.00
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$159,255.45
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$127,194.82 |
| Max. Negotiated Rate |
$159,255.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127,194.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159,255.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142,491.72
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$79,940.49
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$63,847.20 |
| Max. Negotiated Rate |
$79,940.49 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63,847.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79,940.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,525.70
|
|
