|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML (0.5%) SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081888]
|
Facility
OP
|
$2.90
|
|
|
Service Code
|
NDC 50383-741-20
|
| Hospital Charge Code |
1744054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.71
|
| Rate for Payer: BCBS Transplant Transplant |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.18
|
| Rate for Payer: IEHP medi-cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.18
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: Riverside University Health MISP |
$1.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
NDC 73177-146-33
|
| Hospital Charge Code |
1744054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.77
|
| Rate for Payer: BCBS Transplant Transplant |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.25
|
| Rate for Payer: IEHP medi-cal |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: Riverside University Health MISP |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
NDC 73177-146-33
|
| Hospital Charge Code |
1744054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
IP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$2.39
|
| Rate for Payer: Cigna of CA PPO |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
IP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
OP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: BCBS Transplant Transplant |
$2.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$2.39
|
| Rate for Payer: Cigna of CA PPO |
$2.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.56
|
| Rate for Payer: IEHP medi-cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.05
|
| Rate for Payer: Riverside University Health MISP |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
OP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$3.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.81
|
| Rate for Payer: IEHP medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: Riverside University Health MISP |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$3,744.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,744.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$4,462.11
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$19,334.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,334.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$23,040.66
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$8,728.79 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,728.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,401.81
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$5,128.85 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,128.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$6,111.88
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$6,864.97 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,864.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$8,180.76
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$4,559.84 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,559.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,433.81
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$18,125.14 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,125.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$21,599.12
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$5,606.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,606.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$6,680.49
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 894
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY AGE <=21 WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 899
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY AGE >21 WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 898
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 896
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 895
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$5,103.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,103.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$6,081.18
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$10,025.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,025.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$11,947.45
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$21,086.63 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,086.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$25,128.23
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$6,584.95 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,584.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,847.07
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
IP
|
$87.45
|
|
|
Service Code
|
NDC 50242-130-01
|
| Hospital Charge Code |
ERX212384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$65.59
|
| Rate for Payer: Blue Shield of California EPN |
$46.70
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Central Health Plan Commercial |
$69.96
|
| Rate for Payer: Cigna of CA HMO |
$61.22
|
| Rate for Payer: Cigna of CA PPO |
$61.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.98
|
| Rate for Payer: Galaxy Health WC |
$74.33
|
| Rate for Payer: Global Benefits Group Commercial |
$52.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$65.59
|
| Rate for Payer: Networks By Design Commercial |
$56.84
|
| Rate for Payer: Prime Health Services Commercial |
$74.33
|
|
