PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$11,242.70
|
|
Service Code
|
APR-DRG 0483
|
Min. Negotiated Rate |
$9,434.44 |
Max. Negotiated Rate |
$11,242.70 |
Rate for Payer: Adventist Health Medi-Cal |
$9,434.44
|
Rate for Payer: IEHP medi-cal |
$11,242.70
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$20,844.98
|
|
Service Code
|
APR-DRG 0484
|
Min. Negotiated Rate |
$17,492.29 |
Max. Negotiated Rate |
$20,844.98 |
Rate for Payer: Adventist Health Medi-Cal |
$17,492.29
|
Rate for Payer: IEHP medi-cal |
$20,844.98
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
IP
|
$8,283.53
|
|
Service Code
|
APR-DRG 0482
|
Min. Negotiated Rate |
$6,951.22 |
Max. Negotiated Rate |
$8,283.53 |
Rate for Payer: Adventist Health Medi-Cal |
$6,951.22
|
Rate for Payer: IEHP medi-cal |
$8,283.53
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.06
|
|
Service Code
|
NDC 0941-0413-05
|
Hospital Charge Code |
1771149
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.03
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Central Health Plan Commercial |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: Galaxy Health WC |
$0.05
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.05
|
Rate for Payer: Networks By Design Commercial |
$0.04
|
Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0941-0413-04
|
Hospital Charge Code |
NDG27801
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Cash Price |
$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 |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
Rate for Payer: IEHP medi-cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
Rate for Payer: Riverside University Health MISP |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.01
|
|
Service Code
|
NDC 0941-0413-01
|
Hospital Charge Code |
1771281
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 0941-0413-04
|
Hospital Charge Code |
NDG27801
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$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: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
IP
|
$0.01
|
|
Service Code
|
NDC 0941-0413-07
|
Hospital Charge Code |
NDG27801A
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.06
|
|
Service Code
|
NDC 0941-0413-05
|
Hospital Charge Code |
1771149
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
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: BCBS Transplant Transplant |
$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: Cash Price |
$0.03
|
Rate for Payer: Central Health Plan Commercial |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.04
|
Rate for Payer: Cigna of CA PPO |
$0.04
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
Rate for Payer: Galaxy Health WC |
$0.05
|
Rate for Payer: Global Benefits Group Commercial |
$0.04
|
Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
Rate for Payer: IEHP medi-cal |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.05
|
Rate for Payer: Networks By Design Commercial |
$0.04
|
Rate for Payer: Prime Health Services Commercial |
$0.05
|
Rate for Payer: Riverside University Health MISP |
$0.02
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
Rate for Payer: United Healthcare All Other HMO |
$0.03
|
Rate for Payer: United Healthcare HMO Rider |
$0.03
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.01
|
|
Service Code
|
NDC 0941-0413-07
|
Hospital Charge Code |
NDG27801A
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.00
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: Cigna of CA HMO |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
Rate for Payer: IEHP medi-cal |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
Rate for Payer: Riverside University Health MISP |
$0.00
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27801]
|
Facility
OP
|
$0.01
|
|
Service Code
|
NDC 0941-0413-01
|
Hospital Charge Code |
1771281
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.00
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: Cigna of CA HMO |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
Rate for Payer: IEHP medi-cal |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
Rate for Payer: Riverside University Health MISP |
$0.00
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.01
|
|
Service Code
|
NDC 0941-0415-01
|
Hospital Charge Code |
1771282
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 0941-0429-52
|
Hospital Charge Code |
1771289
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$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: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.01
|
|
Service Code
|
NDC 0941-0415-01
|
Hospital Charge Code |
1771282
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.00
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: Cigna of CA HMO |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
Rate for Payer: IEHP medi-cal |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
Rate for Payer: Riverside University Health MISP |
$0.00
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0941-0415-04
|
Hospital Charge Code |
NDG27805
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Cash Price |
$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 |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
Rate for Payer: IEHP medi-cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
Rate for Payer: Riverside University Health MISP |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 0941-0415-06
|
Hospital Charge Code |
1771289
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$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: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 0941-0415-04
|
Hospital Charge Code |
NDG27805
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$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: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.01
|
|
Service Code
|
NDC 0941-0415-07
|
Hospital Charge Code |
NDG27805A
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0941-0415-06
|
Hospital Charge Code |
1771289
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Cash Price |
$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 |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
Rate for Payer: IEHP medi-cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
Rate for Payer: Riverside University Health MISP |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0941-0429-52
|
Hospital Charge Code |
1771289
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Cash Price |
$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 |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
Rate for Payer: IEHP medi-cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
Rate for Payer: Riverside University Health MISP |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
IP
|
$0.04
|
|
Service Code
|
NDC 0941-0415-05
|
Hospital Charge Code |
1771156
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.04 |
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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.03
|
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
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.04
|
|
Service Code
|
NDC 0941-0415-05
|
Hospital Charge Code |
1771156
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.04 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
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: BCBS Transplant Transplant |
$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: 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: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
Rate for Payer: IEHP medi-cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
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
|
Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.03
|
Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
PERITON. DIALYSIS SOLN 3-4.25 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L [27805]
|
Facility
OP
|
$0.01
|
|
Service Code
|
NDC 0941-0415-07
|
Hospital Charge Code |
NDG27805A
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.00
|
Rate for Payer: Central Health Plan Commercial |
$0.01
|
Rate for Payer: Cigna of CA HMO |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
Rate for Payer: Galaxy Health WC |
$0.01
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
Rate for Payer: IEHP medi-cal |
$0.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.01
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.01
|
Rate for Payer: Riverside University Health MISP |
$0.00
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L [27796]
|
Facility
IP
|
$0.02
|
|
Service Code
|
NDC 0941-0409-05
|
Hospital Charge Code |
1771265
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$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: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L [27796]
|
Facility
OP
|
$0.02
|
|
Service Code
|
NDC 0941-0409-05
|
Hospital Charge Code |
1771265
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
Rate for Payer: BCBS Transplant Transplant |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.01
|
Rate for Payer: Blue Shield of California EPN |
$0.01
|
Rate for Payer: Cash Price |
$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 |
$0.01
|
Rate for Payer: Cigna of CA PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
Rate for Payer: Galaxy Health WC |
$0.02
|
Rate for Payer: Global Benefits Group Commercial |
$0.01
|
Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
Rate for Payer: IEHP medi-cal |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: Networks By Design Commercial |
$0.01
|
Rate for Payer: Prime Health Services Commercial |
$0.02
|
Rate for Payer: Riverside University Health MISP |
$0.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
Rate for Payer: United Healthcare All Other HMO |
$0.01
|
Rate for Payer: United Healthcare HMO Rider |
$0.01
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|