|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$26,032.12
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$26,032.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,032.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,815.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,542.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,996.46
|
| Rate for Payer: EPIC Health Plan Senior |
$15,997.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,543.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,360.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,488.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,543.31
|
| Rate for Payer: Prime Health Services Medicare |
$15,415.91
|
| 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
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$41,018.16
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$41,018.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,018.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,496.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,095.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,954.22
|
| Rate for Payer: EPIC Health Plan Senior |
$24,636.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,396.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,355.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,011.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,396.50
|
| Rate for Payer: Prime Health Services Medicare |
$23,740.29
|
| 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
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$18,875.99
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,875.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,875.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,193.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,070.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,808.88
|
| Rate for Payer: EPIC Health Plan Senior |
$11,872.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,793.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,110.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,462.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,793.26
|
| Rate for Payer: Prime Health Services Medicare |
$11,440.86
|
| 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
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
OP
|
$759.38
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.88 |
| Max. Negotiated Rate |
$1,919.86 |
| Rate for Payer: Adventist Health Commercial |
$151.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,919.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$470.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.66
|
| Rate for Payer: Blue Shield of California Commercial |
$345.15
|
| Rate for Payer: Blue Shield of California EPN |
$313.77
|
| Rate for Payer: Cash Price |
$341.72
|
| Rate for Payer: Cash Price |
$341.72
|
| Rate for Payer: Central Health Plan Commercial |
$607.50
|
| Rate for Payer: Cigna of CA HMO |
$531.57
|
| Rate for Payer: Cigna of CA PPO |
$531.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$645.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.75
|
| Rate for Payer: EPIC Health Plan Senior |
$303.75
|
| Rate for Payer: Galaxy Health WC |
$645.47
|
| Rate for Payer: Global Benefits Group Commercial |
$455.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$683.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$341.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$482.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$448.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$531.57
|
| Rate for Payer: Multiplan Commercial |
$569.53
|
| Rate for Payer: Networks By Design Commercial |
$379.69
|
| Rate for Payer: Prime Health Services Commercial |
$645.47
|
| Rate for Payer: Riverside University Health System MISP |
$303.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$277.40
|
| Rate for Payer: United Healthcare HMO Rider |
$271.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.47
|
| Rate for Payer: Vantage Medical Group Senior |
$645.47
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
IP
|
$759.38
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.88 |
| Max. Negotiated Rate |
$683.44 |
| Rate for Payer: Adventist Health Commercial |
$151.88
|
| Rate for Payer: Blue Shield of California Commercial |
$609.02
|
| Rate for Payer: Blue Shield of California EPN |
$382.73
|
| Rate for Payer: Cash Price |
$341.72
|
| Rate for Payer: Central Health Plan Commercial |
$607.50
|
| Rate for Payer: Cigna of CA HMO |
$531.57
|
| Rate for Payer: Cigna of CA PPO |
$531.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.75
|
| Rate for Payer: EPIC Health Plan Senior |
$303.75
|
| Rate for Payer: Galaxy Health WC |
$645.47
|
| Rate for Payer: Global Benefits Group Commercial |
$455.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$683.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$482.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$448.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.88
|
| Rate for Payer: Multiplan Commercial |
$569.53
|
| Rate for Payer: Networks By Design Commercial |
$379.69
|
| Rate for Payer: Prime Health Services Commercial |
$645.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$277.40
|
| Rate for Payer: United Healthcare HMO Rider |
$271.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.70
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.69
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California Commercial |
$225.35
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.02
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California Commercial |
$225.35
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.02
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.69
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$28,932.48
|
|
|
Service Code
|
MSDRG 200
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$28,932.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,932.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,689.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,165.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,504.26
|
| Rate for Payer: EPIC Health Plan Senior |
$17,669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,063.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,488.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,524.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,063.19
|
| Rate for Payer: Prime Health Services Medicare |
$17,026.98
|
| 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
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$46,429.35
|
|
|
Service Code
|
MSDRG 199
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$46,429.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,429.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,991.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,989.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,633.08
|
| Rate for Payer: EPIC Health Plan Senior |
$27,755.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,232.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,325.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,811.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,232.17
|
| Rate for Payer: Prime Health Services Medicare |
$26,746.10
|
| 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
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$18,820.72
|
|
|
Service Code
|
MSDRG 201
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,820.72 |
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18,820.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,157.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,020.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,761.08
|
| Rate for Payer: EPIC Health Plan Senior |
$11,840.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,764.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,070.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,424.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,764.29
|
| Rate for Payer: Prime Health Services Medicare |
$11,410.15
|
| 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 Select/Navigate/Core |
$6,823.00
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$41,278.72
|
|
|
Service Code
|
MSDRG 917
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$41,278.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,278.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,664.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,331.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,179.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24,786.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,533.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,546.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,194.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,533.04
|
| Rate for Payer: Prime Health Services Medicare |
$23,885.02
|
| 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
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$22,558.01
|
|
|
Service Code
|
MSDRG 918
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,558.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,558.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,571.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,400.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,992.57
|
| Rate for Payer: EPIC Health Plan Senior |
$13,995.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,722.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,811.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,048.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,722.77
|
| Rate for Payer: Prime Health Services Medicare |
$13,486.14
|
| 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
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$8,850.35
|
|
|
Service Code
|
APR-DRG 8122
|
| Min. Negotiated Rate |
$5,589.70 |
| Max. Negotiated Rate |
$8,850.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,589.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,661.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,850.35
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$5,728.35
|
|
|
Service Code
|
APR-DRG 8121
|
| Min. Negotiated Rate |
$3,617.90 |
| Max. Negotiated Rate |
$5,728.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,617.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,311.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,728.35
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$13,922.08
|
|
|
Service Code
|
APR-DRG 8123
|
| Min. Negotiated Rate |
$8,792.89 |
| Max. Negotiated Rate |
$13,922.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,792.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,478.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,922.08
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$26,708.17
|
|
|
Service Code
|
APR-DRG 8124
|
| Min. Negotiated Rate |
$16,868.32 |
| Max. Negotiated Rate |
$26,708.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,868.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,101.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,708.17
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [225066]
|
Facility
|
OP
|
$23,673.71
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.61 |
| Max. Negotiated Rate |
$21,306.34 |
| Rate for Payer: Adventist Health Commercial |
$4,734.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.61
|
| Rate for Payer: Blue Shield of California Commercial |
$170.37
|
| Rate for Payer: Blue Shield of California EPN |
$154.88
|
| Rate for Payer: Cash Price |
$10,653.17
|
| Rate for Payer: Cash Price |
$10,653.17
|
| Rate for Payer: Central Health Plan Commercial |
$18,938.97
|
| Rate for Payer: Cigna of CA HMO |
$16,571.60
|
| Rate for Payer: Cigna of CA PPO |
$16,571.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,571.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.96
|
| Rate for Payer: EPIC Health Plan Senior |
$157.97
|
| Rate for Payer: Galaxy Health WC |
$20,122.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,204.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,306.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,032.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,734.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.44
|
| Rate for Payer: Multiplan Commercial |
$17,755.28
|
| Rate for Payer: Networks By Design Commercial |
$11,836.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.61
|
| Rate for Payer: Prime Health Services Commercial |
$20,122.65
|
| Rate for Payer: Prime Health Services Medicare |
$152.23
|
| Rate for Payer: Riverside University Health System MISP |
$157.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,204.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,204.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,884.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8,648.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,460.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,753.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.97
|
| Rate for Payer: Vantage Medical Group Senior |
$157.97
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [225066]
|
Facility
|
IP
|
$23,673.71
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,734.74 |
| Max. Negotiated Rate |
$21,306.34 |
| Rate for Payer: Adventist Health Commercial |
$4,734.74
|
| Rate for Payer: Blue Shield of California Commercial |
$18,986.32
|
| Rate for Payer: Blue Shield of California EPN |
$11,931.55
|
| Rate for Payer: Cash Price |
$10,653.17
|
| Rate for Payer: Central Health Plan Commercial |
$18,938.97
|
| Rate for Payer: Cigna of CA HMO |
$16,571.60
|
| Rate for Payer: Cigna of CA PPO |
$16,571.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,571.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,469.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9,469.48
|
| Rate for Payer: Galaxy Health WC |
$20,122.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,204.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,306.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,032.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,967.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,734.74
|
| Rate for Payer: Multiplan Commercial |
$17,755.28
|
| Rate for Payer: Networks By Design Commercial |
$11,836.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,122.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,884.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8,648.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,460.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,753.14
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]
|
Facility
|
IP
|
$112.95
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Adventist Health Commercial |
$22.59
|
| Rate for Payer: Blue Shield of California Commercial |
$90.59
|
| Rate for Payer: Blue Shield of California EPN |
$56.93
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Central Health Plan Commercial |
$90.36
|
| Rate for Payer: Cigna of CA HMO |
$79.06
|
| Rate for Payer: Cigna of CA PPO |
$79.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Senior |
$45.18
|
| Rate for Payer: Galaxy Health WC |
$96.01
|
| Rate for Payer: Global Benefits Group Commercial |
$67.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$84.71
|
| Rate for Payer: Networks By Design Commercial |
$56.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.39
|
| Rate for Payer: United Healthcare All Other HMO |
$41.26
|
| Rate for Payer: United Healthcare HMO Rider |
$40.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.99
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]
|
Facility
|
OP
|
$112.95
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$292.30 |
| Rate for Payer: Adventist Health Commercial |
$22.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$292.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.08
|
| Rate for Payer: Blue Shield of California Commercial |
$56.12
|
| Rate for Payer: Blue Shield of California EPN |
$51.02
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Central Health Plan Commercial |
$90.36
|
| Rate for Payer: Cigna of CA HMO |
$79.06
|
| Rate for Payer: Cigna of CA PPO |
$79.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Senior |
$45.18
|
| Rate for Payer: Galaxy Health WC |
$96.01
|
| Rate for Payer: Global Benefits Group Commercial |
$67.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.06
|
| Rate for Payer: Multiplan Commercial |
$84.71
|
| Rate for Payer: Networks By Design Commercial |
$56.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.01
|
| Rate for Payer: Riverside University Health System MISP |
$45.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.39
|
| Rate for Payer: United Healthcare All Other HMO |
$41.26
|
| Rate for Payer: United Healthcare HMO Rider |
$40.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.01
|
| Rate for Payer: Vantage Medical Group Senior |
$96.01
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 4580286803
|
| 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
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 4338631208
|
| 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
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 4338631208
|
| 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
|
|
