|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.79
|
| Rate for Payer: Blue Distinction Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$54.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.92
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO |
$47.04
|
| Rate for Payer: Cigna of CA PPO |
$54.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Media |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-00
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Blue Shield of California Commercial |
$52.37
|
| Rate for Payer: Blue Shield of California EPN |
$37.66
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.65
|
| Rate for Payer: Multiplan Commercial |
$58.84
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Blue Shield of California Commercial |
$54.95
|
| Rate for Payer: Blue Shield of California EPN |
$39.51
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$61.74
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Blue Shield of California Commercial |
$52.37
|
| Rate for Payer: Blue Shield of California EPN |
$37.66
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.65
|
| Rate for Payer: Multiplan Commercial |
$58.84
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.98
|
| Rate for Payer: Blue Distinction Transplant |
$46.30
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$45.07
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cigna of CA HMO |
$49.39
|
| Rate for Payer: Cigna of CA PPO |
$57.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: Dignity Health Media |
$65.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$61.74
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Blue Shield of California Commercial |
$52.33
|
| Rate for Payer: Blue Shield of California EPN |
$37.63
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Blue Shield of California Commercial |
$52.33
|
| Rate for Payer: Blue Shield of California EPN |
$37.63
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Blue Shield of California Commercial |
$54.95
|
| Rate for Payer: Blue Shield of California EPN |
$39.51
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$61.74
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.98
|
| Rate for Payer: Blue Distinction Transplant |
$46.30
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$45.07
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cigna of CA HMO |
$49.39
|
| Rate for Payer: Cigna of CA PPO |
$57.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: Dignity Health Media |
$65.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$61.74
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.82
|
| Rate for Payer: Blue Distinction Transplant |
$44.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.21
|
| Rate for Payer: Blue Shield of California EPN |
$42.95
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cigna of CA HMO |
$47.07
|
| Rate for Payer: Cigna of CA PPO |
$54.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Media |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.65
|
| Rate for Payer: Multiplan Commercial |
$58.84
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$36.78
|
| Rate for Payer: United Healthcare HMO Rider |
$36.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Blue Shield of California Commercial |
$104.74
|
| Rate for Payer: Blue Shield of California EPN |
$75.32
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$117.68
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.64
|
| Rate for Payer: Blue Distinction Transplant |
$88.26
|
| Rate for Payer: Blue Shield of California Commercial |
$108.41
|
| Rate for Payer: Blue Shield of California EPN |
$85.91
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cigna of CA HMO |
$94.14
|
| Rate for Payer: Cigna of CA PPO |
$108.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: Dignity Health Media |
$125.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$110.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$117.68
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.55
|
| Rate for Payer: United Healthcare All Other HMO |
$73.55
|
| Rate for Payer: United Healthcare HMO Rider |
$73.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.64
|
| Rate for Payer: Blue Distinction Transplant |
$88.26
|
| Rate for Payer: Blue Shield of California Commercial |
$108.41
|
| Rate for Payer: Blue Shield of California EPN |
$85.91
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cigna of CA HMO |
$94.14
|
| Rate for Payer: Cigna of CA PPO |
$108.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: Dignity Health Media |
$125.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$110.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$117.68
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.55
|
| Rate for Payer: United Healthcare All Other HMO |
$73.55
|
| Rate for Payer: United Healthcare HMO Rider |
$73.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Blue Shield of California Commercial |
$104.74
|
| Rate for Payer: Blue Shield of California EPN |
$75.32
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$117.68
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
|
|
Removal foreign body from external auditory canal; with general anesthesia
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 69205
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Removal impacted cerumen requiring instrumentation, unilateral
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 69210
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
Removal, non-biodegradable drug delivery implant
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 11982
|
| Min. Negotiated Rate |
$213.62 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$806.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$806.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
|
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 20680
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
|
Facility
|
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 20670
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 11200
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion
|
Facility
|
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 36590
|
| Min. Negotiated Rate |
$304.17 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
Removal of tunneled intraperitoneal catheter
|
Facility
|
OP
|
$6,531.38
|
|
|
Service Code
|
CPT 49422
|
| Min. Negotiated Rate |
$597.72 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
Removal, under anesthesia, of external fixation system
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 20694
|
| Min. Negotiated Rate |
$381.27 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,253.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,253.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$14,464.34
|
|
|
Service Code
|
APR-DRG 4441
|
| Min. Negotiated Rate |
$11,095.67 |
| Max. Negotiated Rate |
$14,464.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,095.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,464.34
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$54,383.15
|
|
|
Service Code
|
APR-DRG 4444
|
| Min. Negotiated Rate |
$41,717.60 |
| Max. Negotiated Rate |
$54,383.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41,717.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,383.15
|
|
