|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$8,987.89
|
|
|
Service Code
|
APR-DRG 7562
|
| Min. Negotiated Rate |
$6,894.66 |
| Max. Negotiated Rate |
$8,987.89 |
| Rate for Payer: IEHP Medi-Cal |
$6,894.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,987.89
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$9,317.75
|
|
|
Service Code
|
APR-DRG 7563
|
| Min. Negotiated Rate |
$7,147.70 |
| Max. Negotiated Rate |
$9,317.75 |
| Rate for Payer: IEHP Medi-Cal |
$7,147.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,317.75
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$19,252.68
|
|
|
Service Code
|
APR-DRG 7564
|
| Min. Negotiated Rate |
$14,768.83 |
| Max. Negotiated Rate |
$19,252.68 |
| Rate for Payer: IEHP Medi-Cal |
$14,768.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,252.68
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$6,873.93
|
|
|
Service Code
|
APR-DRG 7561
|
| Min. Negotiated Rate |
$5,273.03 |
| Max. Negotiated Rate |
$6,873.93 |
| Rate for Payer: IEHP Medi-Cal |
$5,273.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,873.93
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$12,096.77
|
|
|
Service Code
|
APR-DRG 1453
|
| Min. Negotiated Rate |
$9,279.49 |
| Max. Negotiated Rate |
$12,096.77 |
| Rate for Payer: IEHP Medi-Cal |
$9,279.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,096.77
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$9,376.29
|
|
|
Service Code
|
APR-DRG 1452
|
| Min. Negotiated Rate |
$7,192.60 |
| Max. Negotiated Rate |
$9,376.29 |
| Rate for Payer: IEHP Medi-Cal |
$7,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,376.29
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$18,428.02
|
|
|
Service Code
|
APR-DRG 1454
|
| Min. Negotiated Rate |
$14,136.23 |
| Max. Negotiated Rate |
$18,428.02 |
| Rate for Payer: IEHP Medi-Cal |
$14,136.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,428.02
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$7,335.03
|
|
|
Service Code
|
APR-DRG 1451
|
| Min. Negotiated Rate |
$5,626.74 |
| Max. Negotiated Rate |
$7,335.03 |
| Rate for Payer: IEHP Medi-Cal |
$5,626.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,335.03
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$9,459.64
|
|
|
Service Code
|
APR-DRG 4692
|
| Min. Negotiated Rate |
$7,256.54 |
| Max. Negotiated Rate |
$9,459.64 |
| Rate for Payer: IEHP Medi-Cal |
$7,256.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,459.64
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$27,623.42
|
|
|
Service Code
|
APR-DRG 4694
|
| Min. Negotiated Rate |
$21,190.07 |
| Max. Negotiated Rate |
$27,623.42 |
| Rate for Payer: IEHP Medi-Cal |
$21,190.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,623.42
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$7,294.23
|
|
|
Service Code
|
APR-DRG 4691
|
| Min. Negotiated Rate |
$5,595.44 |
| Max. Negotiated Rate |
$7,294.23 |
| Rate for Payer: IEHP Medi-Cal |
$5,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,294.23
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$14,764.06
|
|
|
Service Code
|
APR-DRG 4693
|
| Min. Negotiated Rate |
$11,325.59 |
| Max. Negotiated Rate |
$14,764.06 |
| Rate for Payer: IEHP Medi-Cal |
$11,325.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,764.06
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$25,802.08
|
|
|
Service Code
|
APR-DRG 6902
|
| Min. Negotiated Rate |
$19,792.91 |
| Max. Negotiated Rate |
$25,802.08 |
| Rate for Payer: IEHP Medi-Cal |
$19,792.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,802.08
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$83,680.71
|
|
|
Service Code
|
APR-DRG 6904
|
| Min. Negotiated Rate |
$64,191.91 |
| Max. Negotiated Rate |
$83,680.71 |
| Rate for Payer: IEHP Medi-Cal |
$64,191.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83,680.71
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$48,060.77
|
|
|
Service Code
|
APR-DRG 6903
|
| Min. Negotiated Rate |
$36,867.67 |
| Max. Negotiated Rate |
$48,060.77 |
| Rate for Payer: IEHP Medi-Cal |
$36,867.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,060.77
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$13,325.78
|
|
|
Service Code
|
APR-DRG 6901
|
| Min. Negotiated Rate |
$10,222.28 |
| Max. Negotiated Rate |
$13,325.78 |
| Rate for Payer: IEHP Medi-Cal |
$10,222.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,325.78
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$13,336.42
|
|
|
Service Code
|
APR-DRG 1902
|
| Min. Negotiated Rate |
$10,230.44 |
| Max. Negotiated Rate |
$13,336.42 |
| Rate for Payer: IEHP Medi-Cal |
$10,230.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,336.42
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$12,233.32
|
|
|
Service Code
|
APR-DRG 1901
|
| Min. Negotiated Rate |
$9,384.24 |
| Max. Negotiated Rate |
$12,233.32 |
| Rate for Payer: IEHP Medi-Cal |
$9,384.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,233.32
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$24,782.33
|
|
|
Service Code
|
APR-DRG 1904
|
| Min. Negotiated Rate |
$19,010.65 |
| Max. Negotiated Rate |
$24,782.33 |
| Rate for Payer: IEHP Medi-Cal |
$19,010.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,782.33
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$17,078.42
|
|
|
Service Code
|
APR-DRG 1903
|
| Min. Negotiated Rate |
$13,100.94 |
| Max. Negotiated Rate |
$17,078.42 |
| Rate for Payer: IEHP Medi-Cal |
$13,100.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,078.42
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]
|
Facility
OP
|
$0.90
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1715057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Media |
$0.77
|
| Rate for Payer: Dignity Health Media |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1715057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
ACYCLOVIR 200 MG CAPSULE [8969]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1711380
|
|
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: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.35
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| 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 Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
ACYCLOVIR 200 MG CAPSULE [8969]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1711380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| 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 Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
ACYCLOVIR 400 MG TABLET [8971]
|
Facility
IP
|
$0.15
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1711675
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| 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: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
