|
DOXYLAMINE SUCCINATE 25 MG TABLET [14847]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 4116700609
|
| Hospital Charge Code |
1712323
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
DOXYLAMINE SUCCINATE 25 MG TABLET [14847]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 4116700607
|
| Hospital Charge Code |
1712323
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Media |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT [92074]
|
Facility
IP
|
$122.91
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
1720996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$104.47 |
| Rate for Payer: Blue Shield of California Commercial |
$87.51
|
| Rate for Payer: Blue Shield of California EPN |
$62.93
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cigna of CA HMO |
$86.04
|
| Rate for Payer: Cigna of CA PPO |
$86.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.16
|
| Rate for Payer: Galaxy Health WC |
$104.47
|
| Rate for Payer: Global Benefits Group Commercial |
$73.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$98.33
|
| Rate for Payer: Networks By Design Commercial |
$61.46
|
| Rate for Payer: Prime Health Services Commercial |
$104.47
|
|
|
DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT [92074]
|
Facility
OP
|
$122.91
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
1720996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$821.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$104.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$67.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.57
|
| Rate for Payer: BCBS Transplant Transplant |
$73.75
|
| Rate for Payer: Blue Shield of California Commercial |
$90.58
|
| Rate for Payer: Blue Shield of California EPN |
$119.05
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cigna of CA HMO |
$86.04
|
| Rate for Payer: Cigna of CA PPO |
$86.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.47
|
| Rate for Payer: Dignity Health Media |
$104.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.16
|
| Rate for Payer: Galaxy Health WC |
$104.47
|
| Rate for Payer: Global Benefits Group Commercial |
$73.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$92.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$98.33
|
| Rate for Payer: Networks By Design Commercial |
$61.46
|
| Rate for Payer: Prime Health Services Commercial |
$104.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.46
|
| Rate for Payer: United Healthcare All Other HMO |
$61.46
|
| Rate for Payer: United Healthcare HMO Rider |
$61.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.47
|
| Rate for Payer: Vantage Medical Group Senior |
$104.47
|
|
|
DRONABINOL 2.5 MG CAPSULE [9904]
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
NDC 60687-375-11
|
| Hospital Charge Code |
1730003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: BCBS Transplant Transplant |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.25
|
| Rate for Payer: Dignity Health Media |
$5.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$5.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5.25
|
|
|
DRONABINOL 2.5 MG CAPSULE [9904]
|
Facility
IP
|
$6.18
|
|
|
Service Code
|
NDC 60687-375-11
|
| Hospital Charge Code |
1730003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$5.25
|
|
|
DRONABINOL 2.5 MG CAPSULE [9904]
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
NDC 60687-375-01
|
| Hospital Charge Code |
1730003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: BCBS Transplant Transplant |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.25
|
| Rate for Payer: Dignity Health Media |
$5.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$5.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5.25
|
|
|
DRONABINOL 2.5 MG CAPSULE [9904]
|
Facility
IP
|
$2.02
|
|
|
Service Code
|
NDC 67877-753-60
|
| Hospital Charge Code |
1730003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
|
|
DRONABINOL 2.5 MG CAPSULE [9904]
|
Facility
OP
|
$2.02
|
|
|
Service Code
|
NDC 67877-753-60
|
| Hospital Charge Code |
1730003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.72
|
| Rate for Payer: Dignity Health Media |
$1.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1.72
|
|
|
DRONABINOL 2.5 MG CAPSULE [9904]
|
Facility
IP
|
$6.18
|
|
|
Service Code
|
NDC 60687-375-01
|
| Hospital Charge Code |
1730003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$5.25
|
|
|
DRONABINOL 5 MG CAPSULE [9905]
|
Facility
IP
|
$11.77
|
|
|
Service Code
|
NDC 60687-386-21
|
| Hospital Charge Code |
1730005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Blue Shield of California Commercial |
$8.38
|
| Rate for Payer: Blue Shield of California EPN |
$6.03
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$8.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.42
|
| Rate for Payer: Networks By Design Commercial |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
|
|
DRONABINOL 5 MG CAPSULE [9905]
|
Facility
IP
|
$11.77
|
|
|
Service Code
|
NDC 60687-386-11
|
| Hospital Charge Code |
1730005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Blue Shield of California Commercial |
$8.38
|
| Rate for Payer: Blue Shield of California EPN |
$6.03
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$8.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.42
|
| Rate for Payer: Networks By Design Commercial |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
|
|
DRONABINOL 5 MG CAPSULE [9905]
|
Facility
OP
|
$11.77
|
|
|
Service Code
|
NDC 60687-386-11
|
| Hospital Charge Code |
1730005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.01
|
| Rate for Payer: BCBS Transplant Transplant |
$7.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.87
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$8.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Media |
$10.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.42
|
| Rate for Payer: Networks By Design Commercial |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5.88
|
| Rate for Payer: United Healthcare HMO Rider |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
|
|
DRONABINOL 5 MG CAPSULE [9905]
|
Facility
OP
|
$11.77
|
|
|
Service Code
|
NDC 60687-386-21
|
| Hospital Charge Code |
1730005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.01
|
| Rate for Payer: BCBS Transplant Transplant |
$7.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.87
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$8.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Media |
$10.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.42
|
| Rate for Payer: Networks By Design Commercial |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5.88
|
| Rate for Payer: United Healthcare HMO Rider |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
|
|
DRONABINOL 5 MG CAPSULE [9905]
|
Facility
OP
|
$11.57
|
|
|
Service Code
|
NDC 0904-6746-04
|
| Hospital Charge Code |
1730005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.89
|
| Rate for Payer: BCBS Transplant Transplant |
$6.94
|
| Rate for Payer: Blue Shield of California Commercial |
$8.53
|
| Rate for Payer: Blue Shield of California EPN |
$6.76
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cigna of CA HMO |
$8.10
|
| Rate for Payer: Cigna of CA PPO |
$8.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.83
|
| Rate for Payer: Dignity Health Media |
$9.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.63
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$9.26
|
| Rate for Payer: Networks By Design Commercial |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Vantage Medical Group Senior |
$9.83
|
|
|
DRONABINOL 5 MG CAPSULE [9905]
|
Facility
IP
|
$11.57
|
|
|
Service Code
|
NDC 0904-6746-04
|
| Hospital Charge Code |
1730005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Blue Shield of California Commercial |
$8.24
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cigna of CA HMO |
$8.10
|
| Rate for Payer: Cigna of CA PPO |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.63
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$9.26
|
| Rate for Payer: Networks By Design Commercial |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
|
|
DRONEDARONE 400 MG TABLET [98329]
|
Facility
IP
|
$15.20
|
|
|
Service Code
|
NDC 0024-4142-60
|
| Hospital Charge Code |
1712418
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Blue Shield of California Commercial |
$10.82
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
|
|
DRONEDARONE 400 MG TABLET [98329]
|
Facility
OP
|
$15.20
|
|
|
Service Code
|
NDC 0024-4142-60
|
| Hospital Charge Code |
1712418
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.92
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.06
|
| Rate for Payer: BCBS Transplant Transplant |
$9.12
|
| Rate for Payer: Blue Shield of California Commercial |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.88
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Media |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.92
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION [2654]
|
Facility
OP
|
$5.37
|
|
|
Service Code
|
CPT J1790
|
| Hospital Charge Code |
NDG2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: BCBS Transplant Transplant |
$3.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$8.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$3.76
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.56
|
| Rate for Payer: Dignity Health Media |
$4.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.15
|
| Rate for Payer: Galaxy Health WC |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.56
|
| Rate for Payer: Vantage Medical Group Senior |
$4.56
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION [2654]
|
Facility
IP
|
$5.37
|
|
|
Service Code
|
CPT J1790
|
| Hospital Charge Code |
NDG2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.75
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$3.76
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.15
|
| Rate for Payer: Galaxy Health WC |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.56
|
|
|
DROXIDOPA 100 MG CAPSULE [206920]
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 0054-0532-22
|
| Hospital Charge Code |
ERX206920
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: Dignity Health Media |
$1.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
DROXIDOPA 100 MG CAPSULE [206920]
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 0054-0532-22
|
| Hospital Charge Code |
ERX206920
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
IP
|
$9,615.69
|
|
|
Service Code
|
APR-DRG 7703
|
| Min. Negotiated Rate |
$7,376.25 |
| Max. Negotiated Rate |
$9,615.69 |
| Rate for Payer: IEHP Medi-Cal |
$7,376.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,615.69
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
IP
|
$19,579.01
|
|
|
Service Code
|
APR-DRG 7704
|
| Min. Negotiated Rate |
$15,019.16 |
| Max. Negotiated Rate |
$19,579.01 |
| Rate for Payer: IEHP Medi-Cal |
$15,019.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,579.01
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
IP
|
$3,967.24
|
|
|
Service Code
|
APR-DRG 7701
|
| Min. Negotiated Rate |
$3,043.29 |
| Max. Negotiated Rate |
$3,967.24 |
| Rate for Payer: IEHP Medi-Cal |
$3,043.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,967.24
|
|
