|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$189,986.33
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$100,460.87 |
| Max. Negotiated Rate |
$189,986.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$189,986.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122,723.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171,817.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$165,760.44
|
| Rate for Payer: EPIC Health Plan Senior |
$110,506.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$100,460.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140,645.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134,617.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$100,460.87
|
| Rate for Payer: Prime Health Services Medicare |
$106,488.52
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$290,066.96
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$152,906.52 |
| Max. Negotiated Rate |
$290,066.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$290,066.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187,371.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262,326.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$252,295.76
|
| Rate for Payer: EPIC Health Plan Senior |
$168,197.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$152,906.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214,069.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$204,894.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$152,906.52
|
| Rate for Payer: Prime Health Services Medicare |
$162,080.91
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$147,965.42
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$78,440.49 |
| Max. Negotiated Rate |
$147,965.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$147,965.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95,579.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133,814.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$129,426.81
|
| Rate for Payer: EPIC Health Plan Senior |
$86,284.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78,440.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109,816.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105,110.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$78,440.49
|
| Rate for Payer: Prime Health Services Medicare |
$83,146.92
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$175,853.03
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$93,054.55 |
| Max. Negotiated Rate |
$175,853.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$175,853.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113,593.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159,035.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$153,540.01
|
| Rate for Payer: EPIC Health Plan Senior |
$102,360.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$93,054.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130,276.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124,693.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$93,054.55
|
| Rate for Payer: Prime Health Services Medicare |
$98,637.82
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$111,613.62
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$59,390.93 |
| Max. Negotiated Rate |
$111,613.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111,613.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72,097.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100,939.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,995.03
|
| Rate for Payer: EPIC Health Plan Senior |
$65,330.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,390.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83,147.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79,583.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$59,390.93
|
| Rate for Payer: Prime Health Services Medicare |
$62,954.39
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$32,659.25
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$32,659.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,659.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,096.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,535.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,726.65
|
| Rate for Payer: EPIC Health Plan Senior |
$19,817.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,016.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,222.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,141.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,016.15
|
| Rate for Payer: Prime Health Services Medicare |
$19,097.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$44,992.33
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$44,992.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,992.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,063.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,689.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,390.53
|
| Rate for Payer: EPIC Health Plan Senior |
$26,927.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,479.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,802.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,479.11
|
| Rate for Payer: Prime Health Services Medicare |
$25,947.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$24,208.22
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$24,208.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,208.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,637.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,893.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,419.41
|
| Rate for Payer: EPIC Health Plan Senior |
$14,946.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,587.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,022.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,207.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,587.52
|
| Rate for Payer: Prime Health Services Medicare |
$14,402.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$62,101.50
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$39,222.00 |
| Max. Negotiated Rate |
$62,101.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,222.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46,739.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62,101.50
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$20,778.38
|
|
|
Service Code
|
APR-DRG 0432
|
| Min. Negotiated Rate |
$13,123.19 |
| Max. Negotiated Rate |
$20,778.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,123.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,638.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,778.38
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$14,459.87
|
|
|
Service Code
|
APR-DRG 0431
|
| Min. Negotiated Rate |
$9,132.55 |
| Max. Negotiated Rate |
$14,459.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,132.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,882.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,459.87
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$31,862.47
|
|
|
Service Code
|
APR-DRG 0433
|
| Min. Negotiated Rate |
$20,123.66 |
| Max. Negotiated Rate |
$31,862.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,123.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,980.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,862.47
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$44,624.39
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$28,183.82 |
| Max. Negotiated Rate |
$44,624.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,183.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33,585.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,624.39
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$24,577.15
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$15,522.41 |
| Max. Negotiated Rate |
$24,577.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,522.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,497.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,577.15
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$15,879.88
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$10,029.40 |
| Max. Negotiated Rate |
$15,879.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,029.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,951.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,879.88
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$12,278.50
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$7,754.84 |
| Max. Negotiated Rate |
$12,278.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,754.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,241.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,278.50
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [120459]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 8770143233
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [120459]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 8770143233
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET [231070]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5789662110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Central Health Plan Commercial |
$0.03
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| 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: Riverside University Health System MISP |
$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
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET [231070]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5789662110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$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
|
|
|
MULTIVITAMINS THERAPEUTIC W/MINERALS TABLET (WRAP) [408120459]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 4098522368
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
MULTIVITAMINS THERAPEUTIC W/MINERALS TABLET (WRAP) [408120459]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5789662110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Central Health Plan Commercial |
$0.03
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| 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: Riverside University Health System MISP |
$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
|
|
|
MULTIVITAMINS THERAPEUTIC W/MINERALS TABLET (WRAP) [408120459]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 4098522368
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
MULTIVITAMINS THERAPEUTIC W/MINERALS TABLET (WRAP) [408120459]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5789662110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$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
|
|
|
MULTIVITAMIN THERAPEUTIC TABLET (WRAP) [4087857]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 8068100300
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Central Health Plan Commercial |
$0.03
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| 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: Riverside University Health System MISP |
$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
|
|
