|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02HL4NZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02WA0NZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$27,899.00
|
|
|
Service Code
|
ICD 09HD0SZ
|
| Min. Negotiated Rate |
$27,899.00 |
| Max. Negotiated Rate |
$27,899.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,899.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02HL3NZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$27,899.00
|
|
|
Service Code
|
ICD 09HD35Z
|
| Min. Negotiated Rate |
$27,899.00 |
| Max. Negotiated Rate |
$27,899.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,899.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$27,899.00
|
|
|
Service Code
|
ICD 09HD36Z
|
| Min. Negotiated Rate |
$27,899.00 |
| Max. Negotiated Rate |
$27,899.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,899.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02HL0NZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$27,899.00
|
|
|
Service Code
|
ICD 09HD05Z
|
| Min. Negotiated Rate |
$27,899.00 |
| Max. Negotiated Rate |
$27,899.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,899.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$25,108.00
|
|
|
Service Code
|
ICD 0VT00ZZ
|
| Min. Negotiated Rate |
$25,108.00 |
| Max. Negotiated Rate |
$25,108.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,108.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$24,272.00
|
|
|
Service Code
|
ICD 0UT9FZL
|
| Min. Negotiated Rate |
$24,272.00 |
| Max. Negotiated Rate |
$24,272.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,272.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$24,272.00
|
|
|
Service Code
|
ICD 0UT74ZZ
|
| Min. Negotiated Rate |
$24,272.00 |
| Max. Negotiated Rate |
$24,272.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,272.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02H43JZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02H44JZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02RJ38Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$27,899.00
|
|
|
Service Code
|
ICD 09HD06Z
|
| Min. Negotiated Rate |
$27,899.00 |
| Max. Negotiated Rate |
$27,899.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,899.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02H44NZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IA Pacemaker - #2632
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 02WA4NZ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE [70544]
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT J1740
|
| Hospital Charge Code |
1721133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$298.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$160.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.82
|
| Rate for Payer: BCBS Transplant Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$73.70
|
| Rate for Payer: Blue Shield of California EPN |
$99.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Media |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE [70544]
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT J1740
|
| Hospital Charge Code |
1721133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Blue Shield of California Commercial |
$71.20
|
| Rate for Payer: Blue Shield of California EPN |
$51.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 9994-2002-74
|
| Hospital Charge Code |
1716048
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| 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
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 24385-905-26
|
| Hospital Charge Code |
NDG10246B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 24385-905-26
|
| Hospital Charge Code |
NDG10246B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 9994-2002-75
|
| Hospital Charge Code |
NDG10246
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| 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
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 68094-503-59
|
| Hospital Charge Code |
NDG10246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| 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 |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| 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 Transplant Other |
$0.12
|
| 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 |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| 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 |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| 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
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 68094-503-59
|
| Hospital Charge Code |
NDG10246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| 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 |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
