|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$50,383.99
|
|
|
Service Code
|
APR-DRG 3253
|
| Min. Negotiated Rate |
$38,649.82 |
| Max. Negotiated Rate |
$50,383.99 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38,649.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50,383.99
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$25,032.39
|
|
|
Service Code
|
APR-DRG 7943
|
| Min. Negotiated Rate |
$19,202.48 |
| Max. Negotiated Rate |
$25,032.39 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,202.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,032.39
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$17,206.12
|
|
|
Service Code
|
APR-DRG 7942
|
| Min. Negotiated Rate |
$13,198.90 |
| Max. Negotiated Rate |
$17,206.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,206.12
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$13,386.07
|
|
|
Service Code
|
APR-DRG 7941
|
| Min. Negotiated Rate |
$10,268.52 |
| Max. Negotiated Rate |
$13,386.07 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,268.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,386.07
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$44,802.91
|
|
|
Service Code
|
APR-DRG 7944
|
| Min. Negotiated Rate |
$34,368.55 |
| Max. Negotiated Rate |
$44,802.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,368.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44,802.91
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$54,519.70
|
|
|
Service Code
|
APR-DRG 9524
|
| Min. Negotiated Rate |
$41,822.35 |
| Max. Negotiated Rate |
$54,519.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41,822.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,519.70
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$30,996.54
|
|
|
Service Code
|
APR-DRG 9523
|
| Min. Negotiated Rate |
$23,777.61 |
| Max. Negotiated Rate |
$30,996.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,777.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,996.54
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$19,456.63
|
|
|
Service Code
|
APR-DRG 9522
|
| Min. Negotiated Rate |
$14,925.28 |
| Max. Negotiated Rate |
$19,456.63 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,925.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,456.63
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$14,127.37
|
|
|
Service Code
|
APR-DRG 9521
|
| Min. Negotiated Rate |
$10,837.18 |
| Max. Negotiated Rate |
$14,127.37 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,837.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,127.37
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
|
IP
|
$9,629.88
|
|
|
Service Code
|
APR-DRG 4262
|
| Min. Negotiated Rate |
$7,387.13 |
| Max. Negotiated Rate |
$9,629.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,387.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,629.88
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
|
IP
|
$14,075.96
|
|
|
Service Code
|
APR-DRG 4263
|
| Min. Negotiated Rate |
$10,797.74 |
| Max. Negotiated Rate |
$14,075.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,797.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,075.96
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
|
IP
|
$7,271.19
|
|
|
Service Code
|
APR-DRG 4261
|
| Min. Negotiated Rate |
$5,577.77 |
| Max. Negotiated Rate |
$7,271.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,577.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,271.19
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
|
IP
|
$24,957.91
|
|
|
Service Code
|
APR-DRG 4264
|
| Min. Negotiated Rate |
$19,145.34 |
| Max. Negotiated Rate |
$24,957.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,145.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,957.91
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$10,066.16
|
|
|
Service Code
|
APR-DRG 0461
|
| Min. Negotiated Rate |
$7,721.81 |
| Max. Negotiated Rate |
$10,066.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,721.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,066.16
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$12,690.88
|
|
|
Service Code
|
APR-DRG 0462
|
| Min. Negotiated Rate |
$9,735.24 |
| Max. Negotiated Rate |
$12,690.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,735.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,690.88
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$15,679.16
|
|
|
Service Code
|
APR-DRG 0463
|
| Min. Negotiated Rate |
$12,027.57 |
| Max. Negotiated Rate |
$15,679.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,027.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,679.16
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$27,517.00
|
|
|
Service Code
|
APR-DRG 0464
|
| Min. Negotiated Rate |
$21,108.43 |
| Max. Negotiated Rate |
$27,517.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,108.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,517.00
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 0143-9318-01
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Blue Distinction Transplant |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$3.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.68
|
| Rate for Payer: Dignity Health Media |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Senior |
$3.68
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 25021-316-04
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Distinction Transplant |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Media |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 43066-997-01
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: Blue Distinction Transplant |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 43066-997-10
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: Blue Distinction Transplant |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$5.24
|
|
|
Service Code
|
NDC 67457-852-04
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.12
|
| Rate for Payer: Blue Distinction Transplant |
$3.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$3.35
|
| Rate for Payer: Cigna of CA PPO |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.45
|
| Rate for Payer: Dignity Health Media |
$4.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.19
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.45
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 70121-1576-7
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.77
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.33
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
NDC 63323-940-21
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Distinction Transplant |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: Dignity Health Media |
$2.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.24
|
|
|
Service Code
|
NDC 67457-852-00
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$2.68
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.19
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
|
