|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]
|
Facility
OP
|
$434.29
|
|
|
Service Code
|
NDC 69344-102-33
|
| Hospital Charge Code |
1748065
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$78.61 |
| Max. Negotiated Rate |
$369.15 |
| Rate for Payer: Adventist Health Commercial |
$86.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$369.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$238.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$325.72
|
| Rate for Payer: Blue Shield of California Commercial |
$269.69
|
| Rate for Payer: Blue Shield of California EPN |
$254.93
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.15
|
| Rate for Payer: Dignity Health Senior |
$369.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.83
|
| Rate for Payer: Heritage Provider Network Senior |
$268.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.57
|
| Rate for Payer: Multiplan Commercial |
$325.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.15
|
| Rate for Payer: Vantage Medical Group Senior |
$369.15
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]
|
Facility
IP
|
$434.29
|
|
|
Service Code
|
NDC 69344-102-33
|
| Hospital Charge Code |
1748065
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$78.61 |
| Max. Negotiated Rate |
$325.72 |
| Rate for Payer: Adventist Health Commercial |
$86.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.36
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.01
|
| Rate for Payer: Heritage Provider Network Senior |
$294.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.57
|
| Rate for Payer: Multiplan Commercial |
$325.72
|
|
|
INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE [14628]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 68462-325-60
|
| Hospital Charge Code |
1710396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE [14628]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 68462-325-60
|
| Hospital Charge Code |
1710396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
IP
|
$2,899.13
|
|
|
Service Code
|
APR-DRG 1131
|
| Min. Negotiated Rate |
$2,899.13 |
| Max. Negotiated Rate |
$2,899.13 |
| Rate for Payer: IEHP Medi-Cal |
$2,899.13
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
IP
|
$10,195.70
|
|
|
Service Code
|
APR-DRG 1134
|
| Min. Negotiated Rate |
$10,195.70 |
| Max. Negotiated Rate |
$10,195.70 |
| Rate for Payer: IEHP Medi-Cal |
$10,195.70
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
IP
|
$4,279.05
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$4,279.05 |
| Max. Negotiated Rate |
$4,279.05 |
| Rate for Payer: IEHP Medi-Cal |
$4,279.05
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
IP
|
$6,234.02
|
|
|
Service Code
|
APR-DRG 1133
|
| Min. Negotiated Rate |
$6,234.02 |
| Max. Negotiated Rate |
$6,234.02 |
| Rate for Payer: IEHP Medi-Cal |
$6,234.02
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$9,031.66
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$9,031.66 |
| Max. Negotiated Rate |
$9,031.66 |
| Rate for Payer: IEHP Medi-Cal |
$9,031.66
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$21,406.18
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$21,406.18 |
| Max. Negotiated Rate |
$21,406.18 |
| Rate for Payer: IEHP Medi-Cal |
$21,406.18
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$39,478.47
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$39,478.47 |
| Max. Negotiated Rate |
$39,478.47 |
| Rate for Payer: IEHP Medi-Cal |
$39,478.47
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$13,064.98
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$13,064.98 |
| Max. Negotiated Rate |
$13,064.98 |
| Rate for Payer: IEHP Medi-Cal |
$13,064.98
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$15,774.08
|
|
|
Service Code
|
APR-DRG 2454
|
| Min. Negotiated Rate |
$15,774.08 |
| Max. Negotiated Rate |
$15,774.08 |
| Rate for Payer: IEHP Medi-Cal |
$15,774.08
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$6,292.72
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$6,292.72 |
| Max. Negotiated Rate |
$6,292.72 |
| Rate for Payer: IEHP Medi-Cal |
$6,292.72
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$9,027.69
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$9,027.69 |
| Max. Negotiated Rate |
$9,027.69 |
| Rate for Payer: IEHP Medi-Cal |
$9,027.69
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$4,933.69
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$4,933.69 |
| Max. Negotiated Rate |
$4,933.69 |
| Rate for Payer: IEHP Medi-Cal |
$4,933.69
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
IP
|
$570.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
1757347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.59
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$262.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.89
|
| Rate for Payer: Heritage Provider Network Senior |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$190.44
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
OP
|
$570.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
1757347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.02
|
| Rate for Payer: Blue Shield of California Commercial |
$48.45
|
| Rate for Payer: Blue Shield of California EPN |
$48.45
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$262.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.38
|
| Rate for Payer: Dignity Health Senior |
$35.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$32.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.91
|
| Rate for Payer: Heritage Provider Network Senior |
$263.91
|
| Rate for Payer: Humana Medicare |
$32.16
|
| Rate for Payer: IEHP Medi-Cal |
$57.13
|
| Rate for Payer: IEHP Medicare Advantage |
$32.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.52
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.38
|
| Rate for Payer: TriValley Medical Group Senior |
$32.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$190.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.38
|
| Rate for Payer: Vantage Medical Group Senior |
$32.16
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
OP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-01
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$483.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$497.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.05
|
| Rate for Payer: Blue Shield of California Commercial |
$561.43
|
| Rate for Payer: Blue Shield of California EPN |
$530.69
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.46
|
| Rate for Payer: Dignity Health Senior |
$768.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$578.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.58
|
| Rate for Payer: Heritage Provider Network Senior |
$418.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.02
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$329.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.46
|
| Rate for Payer: Vantage Medical Group Senior |
$768.46
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
IP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-99
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$678.05 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.10
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$612.06
|
| Rate for Payer: Heritage Provider Network Senior |
$612.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.02
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$329.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.05
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
IP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-01
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$678.05 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.10
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$612.06
|
| Rate for Payer: Heritage Provider Network Senior |
$612.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.02
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$329.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.05
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
OP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-99
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$483.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$497.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.05
|
| Rate for Payer: Blue Shield of California Commercial |
$561.43
|
| Rate for Payer: Blue Shield of California EPN |
$530.69
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.46
|
| Rate for Payer: Dignity Health Senior |
$768.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$578.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.58
|
| Rate for Payer: Heritage Provider Network Senior |
$418.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.02
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$329.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.46
|
| Rate for Payer: Vantage Medical Group Senior |
$768.46
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
OP
|
$1,135.54
|
|
|
Service Code
|
NDC 0069-0809-01
|
| Hospital Charge Code |
ERX216056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.53 |
| Max. Negotiated Rate |
$965.21 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$606.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$780.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$965.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$624.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$851.66
|
| Rate for Payer: Blue Shield of California Commercial |
$705.17
|
| Rate for Payer: Blue Shield of California EPN |
$666.56
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$965.21
|
| Rate for Payer: Dignity Health Senior |
$965.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.76
|
| Rate for Payer: Heritage Provider Network Senior |
$525.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$547.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.88
|
| Rate for Payer: Multiplan Commercial |
$851.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$414.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$379.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$965.21
|
| Rate for Payer: Vantage Medical Group Senior |
$965.21
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
IP
|
$1,135.54
|
|
|
Service Code
|
NDC 0069-0809-01
|
| Hospital Charge Code |
ERX216056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.53 |
| Max. Negotiated Rate |
$851.66 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$780.12
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$768.76
|
| Rate for Payer: Heritage Provider Network Senior |
$768.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.88
|
| Rate for Payer: Multiplan Commercial |
$851.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$414.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$379.38
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
IP
|
$13,931.52
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$13,931.52 |
| Max. Negotiated Rate |
$13,931.52 |
| Rate for Payer: IEHP Medi-Cal |
$13,931.52
|
|
