|
Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 19302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,419.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,147.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,139.02
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$8,147.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,999.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,147.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,362.18
|
| Rate for Payer: IEHP medi-cal |
$13,443.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Innovage PACE Commercial |
$12,221.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,147.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,917.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,917.88
|
| Rate for Payer: Multiplan WC |
$11,139.02
|
| Rate for Payer: Preferred Health Network WC |
$11,366.35
|
| Rate for Payer: Prime Health Services Medicare |
$8,636.53
|
| Rate for Payer: Prime Health Services WC |
$11,025.36
|
| Rate for Payer: Riverside University Health MISP |
$8,962.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$21,673.87
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$18,187.86 |
| Max. Negotiated Rate |
$21,673.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,187.86
|
| Rate for Payer: IEHP medi-cal |
$21,673.87
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$45,612.82
|
|
|
Service Code
|
APR-DRG 3624
|
| Min. Negotiated Rate |
$38,276.50 |
| Max. Negotiated Rate |
$45,612.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,276.50
|
| Rate for Payer: IEHP medi-cal |
$45,612.82
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$15,053.45
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$12,632.27 |
| Max. Negotiated Rate |
$15,053.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,632.27
|
| Rate for Payer: IEHP medi-cal |
$15,053.45
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$25,687.49
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$21,555.94 |
| Max. Negotiated Rate |
$25,687.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,555.94
|
| Rate for Payer: IEHP medi-cal |
$25,687.49
|
|
|
Mastectomy, simple, complete
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,147.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,139.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$8,147.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,999.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,147.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,362.18
|
| Rate for Payer: IEHP medi-cal |
$13,443.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Innovage PACE Commercial |
$12,221.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,147.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,917.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,917.88
|
| Rate for Payer: Multiplan WC |
$11,139.02
|
| Rate for Payer: Preferred Health Network WC |
$11,366.35
|
| Rate for Payer: Prime Health Services Medicare |
$8,636.53
|
| Rate for Payer: Prime Health Services WC |
$11,025.36
|
| Rate for Payer: Riverside University Health MISP |
$8,962.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
|
Mastoidectomy; complete
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 69502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Mastopexy
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 19316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,147.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,139.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$8,147.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,999.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,147.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,362.18
|
| Rate for Payer: IEHP medi-cal |
$13,443.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Innovage PACE Commercial |
$12,221.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,147.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,917.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,917.88
|
| Rate for Payer: Multiplan WC |
$11,139.02
|
| Rate for Payer: Preferred Health Network WC |
$11,366.35
|
| Rate for Payer: Prime Health Services Medicare |
$8,636.53
|
| Rate for Payer: Prime Health Services WC |
$11,025.36
|
| Rate for Payer: Riverside University Health MISP |
$8,962.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
|
Maxillectomy; without orbital exenteration
|
Facility
OP
|
$9,608.38
|
|
|
Service Code
|
CPT 31225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$9,608.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,608.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
|
|
MC MICROCATH PHENOM
|
Facility
OP
|
$4,988.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$4,489.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,239.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,743.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,743.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,415.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,946.91
|
| Rate for Payer: BCBS Transplant Transplant |
$2,992.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,137.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,439.13
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,990.40
|
| Rate for Payer: Cigna of CA HMO |
$3,192.32
|
| Rate for Payer: Cigna of CA PPO |
$3,691.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,239.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,995.20
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,489.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,741.00
|
| Rate for Payer: IEHP medi-cal |
$1,745.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,327.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.60
|
| Rate for Payer: Multiplan Commercial |
$3,741.00
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,992.80
|
| Rate for Payer: Riverside University Health MISP |
$1,995.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,992.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,992.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,494.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,494.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,494.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,239.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,239.80
|
|
|
MC MICROCATH PHENOM
|
Facility
IP
|
$4,988.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.60 |
| Max. Negotiated Rate |
$4,489.20 |
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,990.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.20
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,489.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,327.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.60
|
| Rate for Payer: Multiplan Commercial |
$3,741.00
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [10512]
|
Facility
OP
|
$105.14
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
1720158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$579.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.69
|
| Rate for Payer: BCBS Transplant Transplant |
$63.08
|
| Rate for Payer: Blue Shield of California Commercial |
$108.41
|
| Rate for Payer: Blue Shield of California EPN |
$98.55
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Central Health Plan Commercial |
$84.11
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$73.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.06
|
| Rate for Payer: Galaxy Health WC |
$89.37
|
| Rate for Payer: Global Benefits Group Commercial |
$63.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$78.86
|
| Rate for Payer: IEHP medi-cal |
$36.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.03
|
| Rate for Payer: Multiplan Commercial |
$78.86
|
| Rate for Payer: Networks By Design Commercial |
$52.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.37
|
| Rate for Payer: Riverside University Health MISP |
$42.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.57
|
| Rate for Payer: United Healthcare All Other HMO |
$52.57
|
| Rate for Payer: United Healthcare HMO Rider |
$52.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.37
|
| Rate for Payer: Vantage Medical Group Senior |
$89.37
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [10512]
|
Facility
IP
|
$105.14
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
1720158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$94.63 |
| Rate for Payer: Blue Shield of California Commercial |
$78.86
|
| Rate for Payer: Blue Shield of California EPN |
$56.14
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Central Health Plan Commercial |
$84.11
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$73.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.06
|
| Rate for Payer: Galaxy Health WC |
$89.37
|
| Rate for Payer: Global Benefits Group Commercial |
$63.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.03
|
| Rate for Payer: Multiplan Commercial |
$78.86
|
| Rate for Payer: Networks By Design Commercial |
$52.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.37
|
|
|
Meatotomy, cutting of meatus (separate procedure); except infant
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 53020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: IEHP medi-cal |
$4,199.04
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Innovage PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health MISP |
$2,799.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 50268-522-11
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 50268-522-11
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 50268-522-15
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 50268-522-15
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
NDC 68084-490-01
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
NDC 68084-490-11
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
NDC 68084-490-01
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
MECLIZINE 12.5 MG TABLET [12024]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
NDC 68084-490-11
|
| Hospital Charge Code |
1710509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
MECLIZINE 25 MG TABLET [12025]
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
NDC 59746-121-06
|
| Hospital Charge Code |
1710521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
MECLIZINE 25 MG TABLET [12025]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 16571-661-01
|
| Hospital Charge Code |
1710521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
MECLIZINE 25 MG TABLET [12025]
|
Facility
OP
|
$0.38
|
|
|
Service Code
|
NDC 16571-661-01
|
| Hospital Charge Code |
1710521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: BCBS Transplant Transplant |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
| Rate for Payer: IEHP medi-cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: Riverside University Health MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
