|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 7638511401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 0093106101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 6050500800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 6050500800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
SOTALOL ORAL SUSPENSION COMPOUND 5 MG/ML [4080338]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 9994080338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
SOTALOL ORAL SUSPENSION COMPOUND 5 MG/ML [4080338]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 9994080338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
IP
|
$114.18
|
|
|
Service Code
|
NDC 5551348824
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$102.76 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Blue Shield of California Commercial |
$91.57
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Central Health Plan Commercial |
$91.34
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.84
|
| Rate for Payer: Multiplan Commercial |
$85.64
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
OP
|
$114.18
|
|
|
Service Code
|
NDC 5551348824
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$102.76 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$72.39
|
| Rate for Payer: Blue Shield of California EPN |
$45.56
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Central Health Plan Commercial |
$91.34
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.93
|
| Rate for Payer: Multiplan Commercial |
$85.64
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.09
|
| Rate for Payer: United Healthcare All Other HMO |
$57.09
|
| Rate for Payer: United Healthcare HMO Rider |
$57.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.05
|
| Rate for Payer: Vantage Medical Group Senior |
$97.05
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
IP
|
$114.18
|
|
|
Service Code
|
NDC 5551348840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$102.76 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Blue Shield of California Commercial |
$91.57
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Central Health Plan Commercial |
$91.34
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.84
|
| Rate for Payer: Multiplan Commercial |
$85.64
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
|
|
SOTORASIB 120 MG TABLET [231933]
|
Facility
|
OP
|
$114.18
|
|
|
Service Code
|
NDC 5551348840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$102.76 |
| Rate for Payer: Adventist Health Commercial |
$22.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$72.39
|
| Rate for Payer: Blue Shield of California EPN |
$45.56
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Central Health Plan Commercial |
$91.34
|
| Rate for Payer: Cigna of CA HMO |
$79.93
|
| Rate for Payer: Cigna of CA PPO |
$79.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.67
|
| Rate for Payer: EPIC Health Plan Senior |
$45.67
|
| Rate for Payer: Galaxy Health WC |
$97.05
|
| Rate for Payer: Global Benefits Group Commercial |
$68.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.93
|
| Rate for Payer: Multiplan Commercial |
$85.64
|
| Rate for Payer: Networks By Design Commercial |
$74.22
|
| Rate for Payer: Prime Health Services Commercial |
$97.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.09
|
| Rate for Payer: United Healthcare All Other HMO |
$57.09
|
| Rate for Payer: United Healthcare HMO Rider |
$57.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.05
|
| Rate for Payer: Vantage Medical Group Senior |
$97.05
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$19,932.42
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$12,588.90 |
| Max. Negotiated Rate |
$19,932.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,588.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,001.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,932.42
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$28,122.13
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$17,761.34 |
| Max. Negotiated Rate |
$28,122.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,761.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,122.13
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$40,126.69
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$25,343.17 |
| Max. Negotiated Rate |
$40,126.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,343.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,200.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,126.69
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$13,920.07
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$8,791.62 |
| Max. Negotiated Rate |
$13,920.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,791.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,476.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,920.07
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$46,868.88
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$46,868.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,868.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,275.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,386.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,707.20
|
| Rate for Payer: EPIC Health Plan Senior |
$28,471.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,883.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,236.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,683.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,883.15
|
| Rate for Payer: Prime Health Services Medicare |
$27,436.14
|
| 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
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,771.56
|
|
|
Service Code
|
MSDRG 053
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,771.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,771.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,647.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,306.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,771.19
|
| Rate for Payer: EPIC Health Plan Senior |
$15,847.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,406.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,169.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,305.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,406.78
|
| Rate for Payer: Prime Health Services Medicare |
$15,271.19
|
| 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
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$25,590.28
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$16,162.28 |
| Max. Negotiated Rate |
$25,590.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,162.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,260.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,590.28
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$34,899.86
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$22,042.02 |
| Max. Negotiated Rate |
$34,899.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,042.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,266.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,899.86
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$76,134.37
|
|
|
Service Code
|
APR-DRG 3214
|
| Min. Negotiated Rate |
$48,084.86 |
| Max. Negotiated Rate |
$76,134.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$48,084.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57,301.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76,134.37
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$54,634.90
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$34,506.25 |
| Max. Negotiated Rate |
$54,634.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,506.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,119.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54,634.90
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$156,942.83
|
|
|
Service Code
|
MSDRG 457
|
| Min. Negotiated Rate |
$29,434.00 |
| Max. Negotiated Rate |
$156,942.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156,942.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101,378.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141,933.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$137,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91,459.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$83,144.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116,402.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$111,414.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$83,144.97
|
| Rate for Payer: Prime Health Services Medicare |
$88,133.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$90,575.00
|
| Rate for Payer: United Healthcare All Other HMO |
$90,575.00
|
| Rate for Payer: United Healthcare HMO Rider |
$62,293.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57,072.00
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$221,169.08
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$29,434.00 |
| Max. Negotiated Rate |
$221,169.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$221,169.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142,866.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200,017.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$192,722.79
|
| Rate for Payer: EPIC Health Plan Senior |
$128,481.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116,801.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163,522.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156,514.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116,801.69
|
| Rate for Payer: Prime Health Services Medicare |
$123,809.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,148.00
|
| Rate for Payer: United Healthcare All Other HMO |
$112,148.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75,636.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69,294.00
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$109,818.66
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$29,434.00 |
| Max. Negotiated Rate |
$109,818.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109,818.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70,938.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99,316.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,442.98
|
| Rate for Payer: EPIC Health Plan Senior |
$64,295.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,450.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,830.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78,323.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58,450.29
|
| Rate for Payer: Prime Health Services Medicare |
$61,957.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$81,933.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81,933.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53,969.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,445.00
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$59,215.17
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$37,399.06 |
| Max. Negotiated Rate |
$59,215.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$37,399.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44,567.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59,215.17
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$91,003.12
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$57,475.66 |
| Max. Negotiated Rate |
$91,003.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$57,475.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68,491.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91,003.12
|
|
