|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F50.9
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F98.21
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F98.3
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F50.01
|
|
Hospital Revenue Code
|
913
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F50.2
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F50.8
|
|
Hospital Revenue Code
|
913
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F50.9
|
|
Hospital Revenue Code
|
913
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
ICD F50.8
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$943.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Blue Shield of California Commercial |
$943.00
|
| Rate for Payer: Blue Shield of California EPN |
$943.00
|
| Rate for Payer: Health Net Behavioral |
$1,150.00
|
|
|
Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90899
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$674.00
|
|
|
Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 96100
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Blue Shield of California Commercial |
$674.00
|
| Rate for Payer: Blue Shield of California EPN |
$674.00
|
|
|
Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90834
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$674.00
|
|
|
Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90847
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$674.00
|
|
|
Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90853
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$674.00
|
|
|
Partial Hospitalization Substance Abuse - Must be billed w/ specific diagnosis codes in addition to rev code 912
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 96100
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
|
IP
|
$42.60
|
|
|
Service Code
|
NDC 53436-168-30
|
| 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 |
$32.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| 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 53436-168-30
|
| 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 |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.03
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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: InnovAge PACE Commercial |
$21.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.82
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$42.60
|
|
|
Service Code
|
NDC 53436-168-01
|
| 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 |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.03
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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: InnovAge PACE Commercial |
$21.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.82
|
| Rate for Payer: Molina Healthcare of CA 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 53436-168-01
|
| 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 |
$32.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| 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 53436-084-01
|
| 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 |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.03
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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: InnovAge PACE Commercial |
$21.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.82
|
| Rate for Payer: Molina Healthcare of CA 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 53436-084-30
|
| 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 |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.03
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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: InnovAge PACE Commercial |
$21.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.82
|
| Rate for Payer: Molina Healthcare of CA 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 53436-084-01
|
| 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 |
$32.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| 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 53436-084-30
|
| 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 |
$32.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.37
|
| 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 Heart Transplant
|
Facility
|
IP
|
$306,425.00
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$288,191.00 |
| Max. Negotiated Rate |
$306,425.00 |
| Rate for Payer: Blue Distinction Transplant |
$288,191.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$306,425.00
|
|
|
Pediatric Heart Transplant
|
Facility
|
IP
|
$306,425.00
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$288,191.00 |
| Max. Negotiated Rate |
$306,425.00 |
| Rate for Payer: Blue Distinction Transplant |
$288,191.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$306,425.00
|
|
|
Pediatric Kidney Transplant
|
Facility
|
IP
|
$130,645.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$115,724.00 |
| Max. Negotiated Rate |
$130,645.00 |
| Rate for Payer: Blue Distinction Transplant |
$115,724.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$130,645.00
|
|
