|
HYDROXYZINE HCL 50 MG TABLET [3775]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 9992-0012-01
|
| Hospital Charge Code |
1711188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
HYDROXYZINE HCL 50 MG TABLET [3775]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 0093-5062-01
|
| Hospital Charge Code |
1711188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| 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
|
| 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
|
|
|
HYDROXYZINE ORAL SOLUTION (IV FORM) 50 MG/ML [4080433]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 9994-0804-33
|
| Hospital Charge Code |
1715147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
|
|
HYDROXYZINE ORAL SOLUTION (IV FORM) 50 MG/ML [4080433]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 9994-0804-33
|
| Hospital Charge Code |
1715147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.43
|
| Rate for Payer: Blue Distinction Transplant |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Media |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [3777]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0323-02
|
| Hospital Charge Code |
1711071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [3777]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0323-02
|
| Hospital Charge Code |
1711071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [17381]
|
Facility
|
OP
|
$273.92
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
1721174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$232.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.22
|
| Rate for Payer: Blue Distinction Transplant |
$164.35
|
| Rate for Payer: Blue Shield of California Commercial |
$201.88
|
| Rate for Payer: Blue Shield of California EPN |
$34.24
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cigna of CA HMO |
$191.74
|
| Rate for Payer: Cigna of CA PPO |
$191.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.68
|
| Rate for Payer: Dignity Health Media |
$9.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$232.83
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$219.14
|
| Rate for Payer: Networks By Design Commercial |
$136.96
|
| Rate for Payer: Prime Health Services Commercial |
$232.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.96
|
| Rate for Payer: United Healthcare All Other HMO |
$136.96
|
| Rate for Payer: United Healthcare HMO Rider |
$136.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$9.12
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [17381]
|
Facility
|
IP
|
$273.92
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
1721174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$232.83 |
| Rate for Payer: Blue Shield of California Commercial |
$195.03
|
| Rate for Payer: Blue Shield of California EPN |
$140.25
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cigna of CA HMO |
$191.74
|
| Rate for Payer: Cigna of CA PPO |
$191.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.57
|
| Rate for Payer: Galaxy Health WC |
$232.83
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.74
|
| Rate for Payer: Multiplan Commercial |
$219.14
|
| Rate for Payer: Networks By Design Commercial |
$136.96
|
| Rate for Payer: Prime Health Services Commercial |
$232.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.43
|
| Rate for Payer: United Healthcare All Other HMO |
$101.02
|
| Rate for Payer: United Healthcare HMO Rider |
$98.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 54838-511-80
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Distinction Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Media |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 39328-048-16
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 54838-511-80
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 39328-048-16
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS [3782]
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 39328-047-15
|
| Hospital Charge Code |
1719158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna of CA HMO |
$1.86
|
| Rate for Payer: Cigna of CA PPO |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.25
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS [3782]
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 39328-047-15
|
| Hospital Charge Code |
1719158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.58
|
| Rate for Payer: Blue Distinction Transplant |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.55
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna of CA HMO |
$1.86
|
| Rate for Payer: Cigna of CA PPO |
$1.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.25
|
| Rate for Payer: Dignity Health Media |
$2.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 43199-011-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Blue Distinction Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Media |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 42192-339-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Distinction Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Media |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 42192-339-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 43199-011-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION [10239]
|
Facility
|
IP
|
$80.30
|
|
|
Service Code
|
CPT J1980
|
| Hospital Charge Code |
1720837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$68.26 |
| Rate for Payer: Blue Shield of California Commercial |
$57.17
|
| Rate for Payer: Blue Shield of California EPN |
$41.11
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cigna of CA HMO |
$56.21
|
| Rate for Payer: Cigna of CA PPO |
$56.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.12
|
| Rate for Payer: Galaxy Health WC |
$68.26
|
| Rate for Payer: Global Benefits Group Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Multiplan Commercial |
$64.24
|
| Rate for Payer: Networks By Design Commercial |
$40.15
|
| Rate for Payer: Prime Health Services Commercial |
$68.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.32
|
| Rate for Payer: United Healthcare All Other HMO |
$29.61
|
| Rate for Payer: United Healthcare HMO Rider |
$28.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.50
|
|
|
HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION [10239]
|
Facility
|
OP
|
$80.30
|
|
|
Service Code
|
CPT J1980
|
| Hospital Charge Code |
1720837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$223.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.47
|
| Rate for Payer: Blue Distinction Transplant |
$48.18
|
| Rate for Payer: Blue Shield of California Commercial |
$59.18
|
| Rate for Payer: Blue Shield of California EPN |
$35.60
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cigna of CA HMO |
$56.21
|
| Rate for Payer: Cigna of CA PPO |
$56.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.26
|
| Rate for Payer: Dignity Health Media |
$68.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.12
|
| Rate for Payer: Galaxy Health WC |
$68.26
|
| Rate for Payer: Global Benefits Group Commercial |
$48.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Multiplan Commercial |
$64.24
|
| Rate for Payer: Networks By Design Commercial |
$40.15
|
| Rate for Payer: Prime Health Services Commercial |
$68.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.15
|
| Rate for Payer: United Healthcare All Other HMO |
$40.15
|
| Rate for Payer: United Healthcare HMO Rider |
$40.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.26
|
| Rate for Payer: Vantage Medical Group Senior |
$68.26
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$19,461.95
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$14,929.36 |
| Max. Negotiated Rate |
$19,461.95 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,929.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,461.95
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$7,918.50
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$6,074.32 |
| Max. Negotiated Rate |
$7,918.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,074.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,918.50
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$9,676.00
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$7,422.51 |
| Max. Negotiated Rate |
$9,676.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,422.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,676.00
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$13,327.55
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$10,223.63 |
| Max. Negotiated Rate |
$13,327.55 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,223.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,327.55
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$5,297.33
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$4,063.61 |
| Max. Negotiated Rate |
$5,297.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,063.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,297.33
|
|
