|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$46,492.51
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$46,492.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,492.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,032.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,046.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,687.66
|
| Rate for Payer: EPIC Health Plan Senior |
$27,791.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,265.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,371.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,855.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,265.25
|
| Rate for Payer: Prime Health Services Medicare |
$26,781.17
|
| 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
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$19,860.32
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$19,860.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,860.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,828.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,960.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,659.98
|
| Rate for Payer: EPIC Health Plan Senior |
$12,439.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,309.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,832.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,154.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,309.08
|
| Rate for Payer: Prime Health Services Medicare |
$11,987.62
|
| 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
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
|
OP
|
$42.60
|
|
|
Service Code
|
NDC 5343616830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.78
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.82
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
| Rate for Payer: Riverside University Health System MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.30
|
| Rate for Payer: United Healthcare All Other HMO |
$21.30
|
| Rate for Payer: United Healthcare HMO Rider |
$21.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.21
|
| Rate for Payer: Vantage Medical Group Senior |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
|
IP
|
$42.60
|
|
|
Service Code
|
NDC 5343616830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.17
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
|
OP
|
$42.60
|
|
|
Service Code
|
NDC 5343616801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.78
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.82
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
| Rate for Payer: Riverside University Health System MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.30
|
| Rate for Payer: United Healthcare All Other HMO |
$21.30
|
| Rate for Payer: United Healthcare HMO Rider |
$21.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.21
|
| Rate for Payer: Vantage Medical Group Senior |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
|
IP
|
$42.60
|
|
|
Service Code
|
NDC 5343616801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.17
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
|
IP
|
$42.60
|
|
|
Service Code
|
NDC 5343608430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.17
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
|
OP
|
$42.60
|
|
|
Service Code
|
NDC 5343608401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.78
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.82
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
| Rate for Payer: Riverside University Health System MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.30
|
| Rate for Payer: United Healthcare All Other HMO |
$21.30
|
| Rate for Payer: United Healthcare HMO Rider |
$21.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.21
|
| Rate for Payer: Vantage Medical Group Senior |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
|
OP
|
$42.60
|
|
|
Service Code
|
NDC 5343608430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.78
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.82
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
| Rate for Payer: Riverside University Health System MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.30
|
| Rate for Payer: United Healthcare All Other HMO |
$21.30
|
| Rate for Payer: United Healthcare HMO Rider |
$21.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.21
|
| Rate for Payer: Vantage Medical Group Senior |
$36.21
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
|
IP
|
$42.60
|
|
|
Service Code
|
NDC 5343608401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.17
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Central Health Plan Commercial |
$34.08
|
| Rate for Payer: Cigna of CA HMO |
$29.82
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$36.21
|
| Rate for Payer: Global Benefits Group Commercial |
$25.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$31.95
|
| Rate for Payer: Networks By Design Commercial |
$27.69
|
| Rate for Payer: Prime Health Services Commercial |
$36.21
|
|
|
Pediatric Kidney Transplant Live Donor
|
Facility
|
IP
|
$106,785.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$106,785.00 |
| Max. Negotiated Rate |
$106,785.00 |
| Rate for Payer: Heritage Provider Network Transplant |
$106,785.00
|
|
|
Pediatric Kidney Transplant Live Donor
|
Facility
|
IP
|
$106,785.00
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$106,785.00 |
| Max. Negotiated Rate |
$106,785.00 |
| Rate for Payer: Heritage Provider Network Transplant |
$106,785.00
|
|
|
Pediatric Kidney Transplant Live Donor
|
Facility
|
IP
|
$106,785.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$106,785.00 |
| Max. Negotiated Rate |
$106,785.00 |
| Rate for Payer: Heritage Provider Network Transplant |
$106,785.00
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 1650008619
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068104900
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| 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 |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 1650007814
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| 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 |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 1650059916
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068104900
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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 |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| 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 |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| 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
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 1650007818
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 1650007814
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| 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 |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| 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 |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 1650007818
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 1650008619
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
PEDIATRIC MULTIVITAMIN CHEWABLE TABLET (WRAP) [408206149]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 1650059916
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS [228315]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 0087040203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS [228315]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 0087040203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
